A Comprehensive Health Effects Assessment of the Use of Sanitizers and Disinfectants during COVID-19 Pandemic: A Global Survey

A Comprehensive Health Effects Assessment of the Use of Sanitizers and Disinfectants during COVID-19 Pandemic: A Global Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comprehensive Health Effects Assessment of the Use of Sanitizers and Disinfectants during COVID-19 Pandemic: A Global Survey Fallah Hashemi, Lori Hoepner, FARAHNAZ Soleimani Hamidinejad, and 138 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2267501/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 May, 2023 Read the published version in Environmental Science and Pollution Research → Version 1 posted 5 You are reading this latest preprint version Abstract COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91056 participants from 154 countries participated in this cross-sectional study through an electronic questionnaire. Results implied that detergents (67%), alcohol-based materials (56%), and chlorinated compounds (32%) were the most commonly used types of sanitizers and disinfectants. Most frequently reported health issues include skin complications 48.8% and respiratory complications 29.8%. The Chi-square test showed a significant association between chlorinated compounds with all possible health complications under investigation (p-value < 0.001). Examination of risk factors based on multivariate regression analysis showed that alcohols-based materials were associated with skin complications (OR, 1.98; 95%CI, 1.87–2.09), per-chlorine was associated with eye complications (OR, 1.83; 95%CI, 1.74–1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90–2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological complications (OR, 2.17; 95%CI, 1.92–2.44). The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics. COVID-19 sanitizers and disinfectants side effects health protocols Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction COVID-19 is one of the great challenges to human health. According to the report of the World Health Organization, by November 16, 2022, 548 million people were infected and more than 6 million deaths worldwide had occurred (WHO, 2022 ). The emergence of new and mutated strains of the virus over time has exacerbated this catastrophic health challenge (Hashemi et al., 2022b ). From the beginning of the coronavirus outbreak until now, simultaneously with treatment measures, health and preventive measures such as strict quarantine, social distancing, hand washing, disinfection of various surfaces, and wearing a mask among others, as health protocols to reduce and cutting off the transmission chain were on the agenda of governments and health organizations (Alimohamadi et al., 2022a ; Amanollahi et al., 2021 ; Hashemi et al., 2022b ). With the hypothesis of the persistence of the virus on different surfaces and its transmission through skin contact, personal and public hygiene by hand washing and disinfection of different surfaces became more important. Among the various surfaces with the most frequent contact were door handles, smartphones, remote controls, keyboards, tables and chairs, light switches, and elevator buttons, etc. (Al-Sayah, 2020 ; Ghafoor et al., 2021 ; Jin et al., 2020 ; Yari et al., 2020 ). The literature shows that coronavirus can float in the air for 3 hours, on smooth surfaces (glass, plastic, banknotes) for 4 to 7 days, on the outer layer of the surgical mask for up to 7 days, on copper surfaces, cardboard, and paper for less than 3 hours and stainless steel up to 72 hours (Chin et al., 2020 ; Dhama et al., 2021 ; Doremalen et al., 2020). The shelf life of the virus depends on various factors such as temperature, relative humidity, and pressure (Dindarloo et al., 2020 ; Kampf, 2020 ). To reduce the spread of the virus and disrupt the transmission chain, disinfection using sanitizers and disinfectants for living and non-living surfaces as an efficient method was recommended by the World Health Organization (WHO) and the US Environmental Protection Agency in accordance with the issued instructions (Chen et al., 2021 ; Dindarloo et al., 2020 ). Sanitizers and disinfectants used include alcohol-based materials, oxidizing agents, detergents, chlorine-releasing agents (sodium hypochlorite, per-chlorine), phenol-based disinfectants, iodine-releasing agents, aldehydes, hydrogen peroxide, and quaternary ammonium compounds, etc. (Al-Sayah, 2020 ; McDonnell and Russell, 1999 ; Rutala and Weber, 2019 ). Using sanitizers and disinfectants may have adverse effects on human health, mainly because of the harmful and corrosive compounds in the composition of most sanitizers and disinfectants, such as chlorine-releasing agents, quaternary ammonium cations, or oxidizing agents (Bonin et al., 2020 ; Dumas et al., 2019 ; Emmanuel et al., 2004 ; Nabi et al., 2020 ). The severity of these side effects may vary depending on the type of chemicals, their target objects (living or non-living surfaces), the frequency and volume of the chemicals, and the risk status of the exposed individual (Prajapati et al., 2022 ). Lack of knowledge and insufficient experience in sanitizer and disinfectant use increases the rate of side effects due to the use of these chemicals (Gharpure et al., 2020 ; Rai et al., 2020 ). Potential acute side effects of using sanitizers and disinfectants include skin complications, itching, sore throat, eyes, and nose irritation, and ailments of the respiratory system (cough, sneezing, shortness of breath). Neurological complications such as headache, dizziness, and vomiting have been also reported (ECDC, 2020 ; Goh et al., 2021 ; Lachenmeier, 2008 ). Regardless of the sanitizer and disinfectant safety information and application instructions prolonged use of these products may cause chronic side effects including disorders of the central nervous system (CNS), reproductive disorders, cancer, pulmonary obstruction, etc. (Choi et al., 2020 ). Although several studies have been conducted regionally in a variety of countries on some of the adverse health effects due to disinfectant use (Dawood et al., 2021 ; Dhama et al., 2021 ; Dindarloo et al., 2020 ; Ghafoor et al., 2021 ; Rosenman et al., 2021 ; Shah et al., 2021 ), the current study is a comprehensive survey aimed to estimate the health effects associated with the use of sanitizers and disinfectants among the general population on a global scale. 2. Methods 2.1. Design, participants, and sampling procedure This study aims to assess the health effects of sanitizers and disinfectants on a global scale. There were no exclusion/inclusion criteria for participation in the study, and all individuals regardless of race, age, gender, occupation, and income level were included. The research project was approved by the ethics committee of Shiraz University of Medical Sciences. This study follows the principles of the Declaration of Helsinki. Survey design (non-interventional) is not considered a clinical trial under Directive 2001/20/EC and Regulation (Europe) No 536/2014. All participants provided online informed consent before the study. 2.2. Measurement Tools 2.2.1. Questionnaire The questionnaire was translated into 26 different languages by native language speakers. The questionnaire includes three parts (including 28 items). The first part (7 questions) was referring to demographic information including age, gender, educational and occupational status, country, place of residence, and income level. The second part (6 questions) includes the type, monthly consumption volume, and the number of daily use of sanitizers and disinfectants for living and non-living surfaces. The chemicals which have been investigated included detergents (Soap and toilet liquid, dishwashing liquid), alcohol or alcohol-based materials, hospital-grade sanitizers (savlon; antiseptic liquid), other commercial sanitizers (chlorhexidine gluconate, bronopol, triclosan), hospital disinfectants (quaternary ammonium, tetra-acetyl ethylenediamine), chlorine-based compounds (sodium hypochlorite, per-chlorine), hydrogen peroxide, and formaldehyde. The third part (13 questions) includes health outcomes. Skin complications (itching and skin irritation, dryness, scaling, and urticaria), ocular (itching and eye irritation, and redness), irritation and itching of the throat, respiratory problems (itching and nasal irritation, runny nose, cough and sneezing, and shortness of breath), and neurological effects (headache, dizziness, and vomiting) were questioned. Questionnaire-related questions and options were reviewed by several specialists, including a dermatologist, otolaryngologist, ophthalmologist, pulmonologist, and chemist, as well as a biostatistics specialist. 2.2.2. Reliability and Validity The reliability of the questionnaire showed good internal consistency (Cronbach’s alpha = 0.90). The validity of the questionnaire for only seven living languages ​​(Arabic, English, French, German, Persian, Russian, and Spanish) which are considered official or secondary languages ​​of several countries, was reviewed by 5 to 7 experts with research backgrounds related and faculty members. These experts assessed the validity in light of five components of necessity, relevance, transparency, simplicity, and ambiguity related to each question. 2.2.3. Data collection procedure The questionnaire was designed using Google Form®. In some countries (e.g., China), lack of access to Google or due to poor bandwidth, other internal platforms (e.g., wenjuanxing) and sites (e.g.; https://www.wjx.cn/ ) were used to create online links to the questionnaire. The questionnaire was distributed via email or social networks such as Telegram, WhatsApp, Instagram, Twitter, LinkedIn, and WeChat, etc. The questionnaire was available online for 9 months from [Aug 2021] to [Apr 2022] to achieve maximum participation. 2.3. Statistical analysis The data were analyzed using IBM SPSS for Windows, version 28.0 (IBM Inc., Armonk, NY). The Chi-square test was used to analyze descriptive statistics (n, %), and to evaluate the significance of the association between variables. To assess risk factors for health outcomes in participants, a multivariable logistic regression analysis was performed, and the relationship between risk factors and adverse effects of using sanitizers and disinfectants are presented as odds ratios (ORs) and 95%CIs, after adjustment for confounders, including age, gender, educational level, occupational status, place of residence (rural and urban areas), and income level. A p-value of < 0.05 was considered statistically significant 3. Result 3.1. Study design and participants Demographic characteristics are shown in Table 1 . A total of 91056 participants [58 845 (64.6%) females and 32211 (35.4%) males]. Respondents were well represented by ages 21 to 30 years (37577, 41.3%), urban areas (76122, 83.6%), bachelor’s degree (38924, 42.7%), and median income (48776, 53.6%). In this study, the income level was considered relative to the average income of each country. Therefore, the majority of participants had an average income in their country. Out of 193 United Nations (UN) members (and 2 countries that are non-member observer states: the Holy See and the State of Palestine), 154 countries participated in this study. The global participation rate was reported to be 79%. 41 countries (21%) from different continents did not participate in the study. According to Table 1 , the number of participating countries from each continent includes Africa (48), America (19), Asia (44), Europe (39), and Oceania (4) countries correctly completed the questionnaire. Table 1 Demographic characteristics of the study (N = 91,056) Characteristics N Male Female Age ≤ 20 9861(10.8) 3502(3.8) 6359(7.0) 21 to 30 37577(41.3) 12637(13.9) 24940(27.4) 31 to 40 22250(24.4) 8093(8.9) 14157(15.5) 41 to 50 13338(14.6) 4744(5.2) 8594(9.4) 51 to 60 5746(6.3) 2150(2.4) 3596(3.9) 60 and over 2284(2.5) 1085(1.2) 1199(1.3) Place of residence Urban 76122(83.6) 25987(28.5) 50135(55.1) Rural 14934(16.4) 6224(6.8) 8710(9.6) Level of education School education 14784(16.2) 5662(6.2) 9122(10.0) Associate degree 12546(13.8) 3673(4.0) 8873(9.7) Bachelor’s degree 38924(42.7) 13457(14.8) 25467(28.0) Masters 16798(18.4) 6348(7.0) 10450(11.5) Ph.D. and postdoctoral 8004(8.8) 3071(3.4) 4933(5.4) Occupational status Unemployed / housewife / student 12571(13.8) 2443(2.7) 10128(11.1) University Student 28104(30.9) 9489(10.4) 18615(20.4) Government employee 26249(28.8) 10038(11.0) 16211(17.8) Private office employee 16619(18.3) 645(7.0) 9974(11.0) Freelance (self-employed) 7513(8.3) 3596(3.9) 3917(4.3) Income Low 8877(9.7) 3004(3.3) 5873(6.4) Lower-middle 11339(12.5) 4325(4.7) 7014(7.7) Middle 48776(53.6) 17165(18.9) 31611(34.7) Upper-middle 18308(20.1) 6276(6.9) 12032(13.2) High-income 3756(4.1) 1441(1.6) 2315(2.5) Number of participating countries by continent: N (RR*) Africa America Asia Europe Oceania 48 (24.6%) 19 (9.7%) 44 (22.5%) 39 (20%) 4 (2%) No participation: N 6 16 4 5 10 *Response Rate 3.2. Type and volume of sanitizers and disinfectants used In the second part of the questionnaire, questions were asked about the type, volume, and number of times of daily use of 5 types of chemical compounds as sanitizers (Fig. 1) and 7 types of substances as disinfectants (Fig. 2). The status of the use of sanitizers and disinfectants is shown in Table 2 and Figs. 1 to 3. The consumption status of the sanitizers for handwashing or other living surfaces is shown in Fig. 1. Compared to other sanitizers, the highest use was detergents (soap and toilet liquid, dishwashing liquid) at 74% (n = 67445), and alcohol or non-commercial sanitizers at 57% (n = 52083). In contrast, chlorine compounds such as sodium hypochlorite at 10.5% (n = 9490) were used less often as sanitizers. Additionally, the status of seven groups of disinfectants, which are used for the disinfection of various high-touch surfaces such as door handles, tables, chairs, remotes, keys, elevator buttons, etc., was explored (Fig. 2). In this group, in addition to detergents at 60% (n = 54445) and alcohol-based products at 55% (n = 49879), which were most used compared to other disinfectants, the use of sodium hypochlorite was reported as a high-consumptive disinfectant at 26% (n = 24296). In contrast, formaldehyde by 1.6% (n = 1441) and per-chlorine by 7.2% (n = 6605) had the lowest consumption as a disinfectant. Table 2 Consumption status of sanitizers and disinfectants frequency of daily use (N/d) Monthly consumption volume (CC) Once a day 1–3/d 4–6/d > 6/d None Low (≤ 100) Average (101 to 300) High (301 to 500) Too much (≥ 500) None Sanitizers : n (%) 11069 (12.2) 29778 (32.7) 27407 (30.1) 21608 (23.7) 1140 (1.3) 22849 (25.1) 45091 (49.5) 13292 (14.6) 8572 (9.4) 1198 (1.3) Monthly consumption volume (L) Once a day 1–3/d 4–6/d > 6/d None Low (≤ 0.5) Average (0.5 to 1) High (1.1 to 2) Too much (> 2) None Disinfectants: n (%) 35959 (39.5) 34436 (37.8) 11158 (12.3) 5159 (5.7) 3990 (4.4) 27727 (30.5) 44686 (49.1) 10783 (11.8) 4978 (5.5) 2816 (3.1) Frequency of use of sanitizers and disinfectants N (%) N (%) Detergents (Soap and toilet liquid, dishwashing liquid) 60948 (67) Alcohol or alcohol-based materials 50984 (56) Sodium hypochlorite (bleach) 29020 (32) Hospital-grade sanitizers (savlon) 16892 (19) Other commercial sanitizers (chlorhexidine gluconate, bronopol, triclosan) 25091 (27.6) Hospital disinfectants (quaternary ammonium, tetra-acetyl ethylenediamine) 14186 (15.6) Per-chlorine 6608 (7.3) Hydrogen peroxide 7380 (8.1) Formaldehyde 1444 (1.6) In terms of the frequency of daily use of sanitizers and disinfectants, the results showed that most participants tended to use sanitizers and disinfectants 1 to 3 times a day (n = 29778, 32.7%) and once a day (n = 35959, 39.5%), respectively. The volume of chemicals used was also one of the important factors in creating the scenarios of possible adverse effects and we found that most of the participants stated using the sanitizers and disinfectants at a volume of approximately 101–300 mL, and 0.5-1 liter per month, respectively (Table 2 ). The continental distribution of the inclination of consumers (individuals) to use sanitizers and disinfectants is shown in Fig. 3. Four groups of countries were determined according to the sanitizers and disinfectant consumption rate: countries with low consumption (blue 3000). The number of countries that were less inclined to use sanitizers and disinfectants was in Africa, while the number of countries with the highest level of consumption was in Asia. Similarly, the continental distribution shows that most countries with moderate consumption of sanitizers and disinfectants were in continental Europe. 3.3. Adverse health outcomes of sanitizers and disinfectants The distribution of the frequency of adverse events showed that the most common complaints reported by the participants were related to skin and respiratory system complications (Fig. 4). The highest and lowest frequencies were related to skin dryness by 72% (n = 65680) and neurological effects (headache, dizziness, and vomiting) by 14.3% (n = 13063), respectively. Table 3 shows the possible adverse health outcomes as a result of the use of sanitizers and disinfectants based on the reports of the participants in this study. There was a significant relationship between the use of chlorine compounds such as sodium hypochlorite and per-chlorine with all the adverse effects (p < 0.001) (Table 3 ). Table 3 Frequency table and the relationship between sanitizers/disinfectants and health outcomes (Chi-square test) Type of chemical Itching and Skin Irritation Skin Dryness Hand Scaling Skin urticaria (Hives) Yes No Yes No Yes No Yes No N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Detergents (Soap and toilet liquid, dishwashing liquid) Yes 29952(32.9) 30996(34.0) 45259(49.7) 15688(17.2) 33286(36.6) 27662(30.4) 7037(7.7) 48320(53.1) P-value < 0.001 < 0.001 < 0.001 < 0.001 Alcohol or alcohol-based materials Yes 24786(27.2) 27300(30.0) 39573(43.5) 26110(28.7) 27979(30.7) 24107(26.5) 10614(11.7) 41472(45.5) P-value < 0.001 < 0.001 < 0.025 < 0.001 Sodium hypochlorite (bleach) Yes 19450(21.4) 7443(8.2) 33453(36.7) 3440(3.8) 29954(32.9) 6940(7.6) 4364(4.8) 12529(13.8) P-value < 0.001 < 0.001 < 0.001 < 0.001 Hospital-grade sanitizers (savlon) Yes 14322(15.7) 14698(16.1) 21417(23.5) 7603(8.3) 15369(16.9) 13651(15.0) 6134(6.7) 22886(25.1) P-value < 0.001 < 0.001 < 0.001 0.022 Other commercial sanitizers Yes 11719(12.9) 13372(14.7) 17880(19.6) 7211(7.9) 13082(14.4) 12009(13.2) 5018(5.5) 20073(22.0) P-value 0.592 < 0.001 0.847 < 0.001 Hospital disinfectants Yes 6501(7.1) 7685(8.4) 10447(11.5) 3739(4.1) 6943(7.6) 7243(8.0) 3432(3.8) 10754(11.8) P-value 0.057 < 0.001 < 0.001 < 0.001 Per-chlorine Yes 4097(4.5) 2511(2.8) 5234(5.7) 1374(1.5) 4581(5.0) 2027(2.2) 1918(2.1) 4690(5.2) P-value < 0.001 < 0.001 < 0.001 < 0.001 Hydrogen peroxide Yes 3788(4.2) 3592(3.9) 5387(5.9) 1993(2.2) 3925(4.3) 3455(3.8) 1872(2.1) 5508(6.0) P-value < 0.001 0.088 0.049 < 0.001 Formaldehyde Yes 768(0.8) 676(0.7) 1000(1.1) 444(0.5) 923(1.0) 521(0.6) 436(0.5) 1008(1.1) P-value < 0.001 0.015 < 0.001 < 0.001 Table 3 Cont. Type of chemical Itching and Eye Irritation Eye Redness Itching and Throat Irritation Itching and Nose Irritation Yes No Yes No Yes No Yes No N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Detergents (Soap and toilet liquid, dishwashing liquid) Yes 6294(6.9) 44654(49.0) 11255(12.3) 49580(54.5) 964(1) 45754(50.2) 12976(14.3) 37971(41.7) P-value 0.039 < 0.001 < 0.001 0.002 Alcohol or non-commercial alcohol-based sanitizers Yes 14108(15.5) 10309(11.3) 9289(10.2) 8077(8.9) 12591(13.8) 39495(43.4) 19692(21.6) 32394(35.6) P-value 0.034 < 0.001 < 0.001 0.068 Sodium hypochlorite (bleach) Yes 15407(16.9) 11487(12.6) 11302(12.4) 12592(13.8) 5502(6.0) 11391(12.5) 17551(19.3) 9342(10.3) P-value < 0.001 < 0.001 < 0.001 < 0.001 Hospital-grade sanitizers Yes 7180 (7.9) 21840(24.0) 5450(6.0) 23570(25.9) 6671(7.3) 22349(24.5) 10359(11.4) 18661(20.5) P-value < 0.001 0.126 0.321 0.210 Other commercial sanitizers Yes 6440(7.1) 18651(20.5) 4482(4.9) 20609(22.6) 6035(6.6) 19056(20.9) 8911(9.8) 16180(17.8) P-value < 0.001 < 0.001 < 0.001 0.055 Hospital disinfectants Yes 3310(3.6) 10876(11.9) 2658(2.9) 11528(12.7) 2978(3.3) 11208(12.3) 4530(5.0) 9656(10.6) P-value < 0.001 0.274 < 0.001 < 0.001 Per-chlorine Yes 2614(2.9) 3994(4.4) 1922(2.1) 4686(5.1) 2624(2.9) 3984(4.4) 3484(3.8) 3124(3.4) P-value < 0.001 < 0.001 < 0.001 < 0.001 Hydrogen peroxide Yes 2084(2.3) 5296(5.8) 1750(1.9) 5630(6.2) 2049(2.3) 5331(5.9) 2579(2.8) 4801(5.3) P-value < 0.001 < 0.001 < 0.001 0.332 Formaldehyde Yes 525(0.6) 919(1.0) 410(0.5) 1034(1.1) 482(0.5) 962(1.1) 715(0.8) 729(0.8) P-value < 0.001 < 0.001 < 0.001 < 0.001 3.3.1. Skin complications The use of detergents and alcohol or alcohol-based products resulted in a greater adverse effect on the skin than other chemicals (Table 3 ). Among the skin complications, the most commonly reported adverse effect was skin dryness. 49.7% (n = 45259) and 43.5% (n = 39573) of the participants complained of dry skin due to the use of detergents and alcohol or alcohol-based materials, respectively. There was a significant relationship between itching and skin irritation with all chemicals (except other commercial sanitizers and hospital disinfectants) (p 0.001). 3.3.2. Ocular complications The contribution of sodium hypochlorite in causing ocular complications was greater than other chemicals. Participants reported itching and ocular irritation by 17% (n = 15407) and ocular redness by 12.5% (n = 11302) after using sodium hypochlorite. The data show a significant relationship between itching and ocular irritation with all sanitizers and disinfectants (except detergents and alcohol or alcohol-based materials) (p < 0.001) (Table 3 ). 3.3.3. Throat complications Participants reported itching and irritation of the throat after using alcohol or alcohol-based products by 13.8% (n = 12591), hospital-grade sanitizers such as savlon by 7.3% (n = 6671), and other commercial sanitizers by 6.6% (n = 6035). Itching and irritation of the throat as one of the possible side effects of sanitizers and disinfectants was significantly associated with some chemicals such as chlorine compounds (sodium hypochlorite & per-chlorine), hospital disinfectants, hydrogen peroxide, formaldehyde (p < 0.001) (Table 3 ). 3.3.4. Respiratory system complications Respiratory complications including itching and nose irritation by 21.6% (n = 19692), runny nose by 13.8% (n = 12601), and cough and sneezing by 22.1% (n = 20148) were reported after using alcohol or alcohol-based products. There was a significant relationship between shortness of breath with all chemicals except detergents (all p 0.001) (Table 3 ). 3.3.5. Neurological complications The present findings showed that less than eight percent of the participants had self-reported neurological complications including headache, dizziness, and vomiting after using sanitizers and disinfectants. In total, 7.8% (n = 7114), and 0.5% (n = 419) of participants complained of headaches, dizziness, and vomiting after using alcohol (the most) and formaldehyde (the least), respectively. The results indicated that a statistically significant relationship was found between possible neurological problems due to the use of analyzed sanitizers and disinfectants (except detergents) (all p < 0.001) (Table 3 ). 3.3. Multivariable logistic regression analysis After controlling for confounders (demographic characteristics), a multivariable logistic regression analysis was performed to determine the risk factors associated with adverse health outcomes (Table 4 ). The use of some sanitizers and disinfectants was associated with skin adverse effects (e.g., Itching and skin irritation after using alcohol or alcohol-based materials: OR, 1.86; 95%CI, p > 0.001; or as a result of using sodium hypochlorite: OR, 1.43; 95%CI, p < 0.001). In contrast, the use of some other sanitizers and disinfectants was associated with a lower chance of itching and skin irritation (hospital disinfectants: OR, 0.91; 95%CI, p < 0.001). The use of Per-chlorine (OR, 1.47; 95%CI, p < 0.001), alcohol-based materials (OR, 1.98; 95%CI, p < 0.001), formaldehyde (OR, 1.40; 95%CI, p < 0.001) were associated with higher odds of skin dryness, scaling of the skin, skin urticaria respectively. Table 4 Risk Factors for Health complications by Multivariable Logistic Regression Analysis Type of chemical Itching and Skin Irritation Skin Dryness Skin scaling Skin urticaria (Hives) Adjusted OR CI (95%) P Adjusted OR CI (95%) P Adjusted OR CI (95%) P Adjusted OR CI (95%) P Detergents (Soap and toilet liquid, dishwashing liquid) 1.15 1.09–1.21 0.001 1.06 1.02–1.10 0.001 1.15 1.11–1.19 0.001 0.94 0.90–0.97 0.001 Alcohol or alcohol-based materials 1.86 1.77–1.96 0.020 1.30 1.26–1.34 0.001 1.98 1.87–2.09 0.001 0.86 0.83–0.89 0.001 Sodium hypochlorite (bleach) 1.43 1.39–1.48 0.001 1.40 1.35–1.46 0.001 1.30 1.24–1.37 0.001 0.90 0.87–0.93 0.001 Hospital-grade sanitizers 1.08 1.05–1.12 0.001 0.82 0.79–0.93 0.001 1.01 0.98–1.04 0.394 0.86 0.83–0.89 0.001 Other commercial sanitizers 0.90 0.87–0.93 0.001 0.86 0.83–0.89 0.001 0.95 0.92–0.98 0.005 0.82 0.79–0.85 0.001 Hospital disinfectants 0.91 0.88–0.95 0.001 1.10 1.06–1.15 0.001 0.84 0.81–0.87 0.001 1.26 1.21–1.32 0.001 Per-chlorine 0.96 0.94–0.99 0.001 1.47 1.38–1.56 0.001 1.37 1.29–1.45 0.001 0.95 0.90–1.01 0.125 Hydrogen peroxide 1.15 1.09–1.21 0.001 0.95 0.90–1.01 0.125 0.96 0.91–1.01 0.136 1.37 1.29–1.45 0.001 Formaldehyde 1.20 1.07–1.34 0.001 0.85 0.76–0.96 0.011 1.46 1.31–1.64 0.001 1.40 1.24–1.57 0.001 Adjusted for age, sex, educational level, occupational status, place of residence (rural & city), and income level. Table 4 Cont. Type of chemical Itching and Eye Irritation Eye Redness Itching and Throat Irritation Itching and Nose Irritation Adjusted OR CI (95%) P Adjusted OR CI (95%) P Adjusted OR CI (95%) P Adjusted OR CI (95%) P Detergents (Soap and toilet liquid, dishwashing liquid) 0.95 0.92–0.98 0.001 0.85 0.82–0.88 0.001 0.69 0.62–0.76 0.063 1.21 1.17–1.24 0.001 Alcohol or alcohol-based materials 1.11 1.07–1.15 0.002 1.05 1.01–1.08 0.001 0.97 0.93–1.00 0.053 1.07 1.04–1.11 0.001 Sodium hypochlorite (bleach) 1.33 1.27–1.40 0.001 1.65 1.58–1.71 0.001 1.66 1.58–1.74 0.001 1.48 1.41–1.55 0.001 Hospital-grade sanitizers 0.83 0.80–0.86 0.001 0.90 0.86–0.93 0.001 0.84 0.81–0.87 0.001 0.87 0.84–0.89 0.001 Other commercial sanitizers 0.89 0.86–0.92 0.001 0.81 0.77–0.84 0.001 0.89 0.86–0.93 0.001 0.85 0.82–0.88 0.001 Hospital disinfectants 0.90 0.86–0.94 0.001 - - - 0.83 0.79–0.87 0.001 0.82 0.79–0.86 0.001 Per-chlorine 1.83 1.74–1.93 0.001 1.77 1.68–1.88 0.001 2.00 1.90–2.11 0.001 1.87 1.78–1.97 0.001 Hydrogen peroxide 1.15 1.09–1.22 0.001 1.49 1.40–1.58 0.001 1.19 1.13–1.26 0.001 0.92 0.87–0.97 0.003 Formaldehyde 1.40 1.26–1.57 0.001 1.34 1.19–1.52 0.001 1.29 1.15–1.45 0.001 1.56 1.40–1.73 0.001 Adjusted for age, sex, educational level, occupational status, place of residence (rural & city), and income level. Itching and ocular irritation were reported after using per-chlorine: OR, 1.83; 95%CI, p < 0.001; and sodium hypochlorite: OR, 1.33; 95%CI, p < 0.001. Similarly, ocular redness was associated with the use of per-chlorine (OR, 1.77; 95%CI, p < 0.001), and hydrogen peroxide (OR, 1.49; 95%CI, p < 0.001). The results showed that one of the important risk factors for throat-related effects is chlorine-based compounds. Per-chlorine resulted in double the risk for throat-related effects (OR, 2.00; 95%CI, p < 0.001), and sodium hypochlorite use is also a serious risk factor for itching and throat irritation (OR, 1.66; 95%CI, p < 0.001). Furthermore, the use of sodium hypochlorite (OR, 1.74; 95%CI, p < 0.001), and formaldehyde (OR, 1.56; 95%CI, p < 0.001) were accompanied by coughing and sneezing. Similarly, shortness of breath was associated with the use of sodium hypochlorite (OR, 1.78; 95%CI, p < 0.001), and per-chlorine (OR, 1.67; 95%CI, p < 0.001). There was a strong association between the use of formaldehyde and the occurrence of neurological complications (OR, 2.17; 95%CI, p < 0.001). 4. Discussion Regarding the use of sanitizers and disinfectants in different continents, it was observed that in African countries, due to low-income levels, and lack of accessibility the tendency to use disinfectants was lower than in other continents. In contrast, in some less-resourced countries, such as Iran, and more-resourced countries, such as China, the US, the UK, Germany, and Australia, etc., there was a greater tendency to use disinfectants. Adequate income levels, adequate education, and information, easy access to the types of sanitizers and disinfectants, and strict controlling measures by the governments have been effective in increasing the use of these chemicals (Becher et al., 2021 ; Bu et al., 2020 ; Tran et al., 2020 ; Unruh et al., 2022 ; Xu et al., 2020 ). Although our claim regarding some countries such as Venezuela, Iraq, Afghanistan, etc. was not correct. Contrary to the economic crisis prevailing in these countries, the use of sanitizers and disinfectants was high. In addition to this more attention and the fear of contracting the disease, sometimes leads to the excessive consumption of sanitizers and disinfectants, which leads to the occurrence of adverse effects due to the toxic nature of these chemicals on the population; finally, the body's resistance to other infectious agents may decrease (Tachikawa, 2020 ; Vogel, 2011 ). On the other hand, the denial of the existential nature of the COVID-19 disease by people from different countries (Afolabi and Ilesanmi, 2021 ; Buguzi, 2021 ; Cabral et al., 2021 ; Thagard, 2021 ) can be one of the main reasons for not tending to use sanitizers and disinfectants as part of health protocols. We found that the disinfectants with the highest rate of causing different adverse health effects are chlorine compounds (sodium hypochlorite and per-chlorine). One of the reasons for this finding could be the widespread use of these compounds as bleaches, cleansers, and vegetable washes, for washing different surfaces, water disinfection as well as easy access and affordability. In addition to the inherent complications of using chemicals as sanitizers and disinfectants, there are other reasons such as misuse (mixing several chemicals without following the instructions), excessive use, and counterfeit and unauthorized products that can cause side effects (Alhouri et al., 2020 ; Cook and Brooke, 2021 ). However, some disinfectants (e.g., detergents) may not have serious adverse effects on human health, but prolonged exposure and overuse of any chemical increase their harmful potential (Baldeo et al., 2022 ). Similar studies have shown that most disinfectants, such as alcohols and proxygene compounds, can be considered potential irritants or skin allergens (Goh et al., 2021 ; Lachenmeier, 2008 ; Murphy and Friedman, 2019 ). The US centers for disease control and prevention (CDC) reported an increase in calls to the center because of overuse and frequent exposure to cleaning chemicals during the Covid-19 pandemic (CDC, 2020 ; Rosenman et al., 2021 ). Various reports have claimed that long-term use of surfactants causes dryness and roughness of the skin (Goh et al., 2021 ; Paudel et al., 2022 ; Shibuya et al., 2022 ). Similarly, alcohol-based substances despite their low permeability to the skin had the most skin effects as a result of prolonged contact and regular and continuous use. Similar studies have reported increased exposure and frequency of alcohol use as a cause of skin irritation or dermatitis (Bouthoorn et al., 2011 ; Ghafoor et al., 2021 ; Lachenmeier, 2008 ). Unlike sanitizers and other disinfectants, alcohols were more effective in causing skin urticaria. In one study, skin urticaria was reported as a result of alcohol use (such as isopropanol) due to the combination of these alcohols with some solvents and organic matter (Berardi et al., 2020 ; Goh and Ahmed, 2020 ; Pecquet et al., 1992 ). The results obtained in this study regarding skin complications were in accordance with some scientific texts and similar studies (Bito et al., 2010 ; Chan and Maibach, 2008 ; Europe, 2017; Murphy and Friedman, 2019 ). The results of the multivariate regression analysis showed that detergents, alcohols or alcohol-based substances, and chlorine compounds have a higher potential of causing skin complications compared to other sanitizers and disinfectants. Ocular complications (itching and irritation and eye redness) due to the use of sanitizers and disinfectants were less common than other complications. However, in terms of frequency, detergents and alcohol accounted for the largest share of ocular side effects. The results of some studies confirm our findings that itching and eye irritation are a result of the use of alcohol as a sanitizer/disinfectant (Ghafoor et al., 2021 ). Statistical results showed that among the chemicals studied, chlorine compounds had a higher chance of causing ocular complications compared to other disinfectants. This is probably due to the wide range of applications of chlorine compounds for different purposes as well as their ability to be mixed with other solvents. Studies have shown that the use of chlorine-based compounds in the form of sprays to disinfect surfaces will cause itching and eye irritation (Ghafoor et al., 2021 ; Schyllert et al., 2016 ; WHO, 2020). Since people used several types of chemicals separately or mixed to wash hands, face, and feet or to disinfect different surfaces, improper mixing of chemicals may release toxic gases and vapors that can affect the respiratory system. Studies have shown that mixing bleach with acidic cleaning agents leads to the release of highly irritating gases (PHE, 2015; Racioppi et al., 1994 ). Rosenman et al. claimed that not following hygienic instructions on how to use or mix cleansing products with other chemicals such as acid would create the conditions for chemical pneumonia or pulmonary edema (Rosenman et al., 2021 ). Our findings showed that chlorine compounds (sodium hypochlorite and per-chlorine) were involved in causing all complications related to the respiratory system. This claim was consistent with a list approved by the US Environmental Protection Agency (Alimohamadi et al., 2022b ) that sodium hypochlorite is an irritant and allergen for the respiratory system (EPA, 2020 ). The results of multivariate regression analysis showed that formaldehyde had an immensely significant chance of causing neurological effects compared to other sanitizers and disinfectants. Formaldehyde, as a carcinogen by OSHA (Tarka et al., 2016 ), has an unpleasant odor and is an irritant that can cause many adverse effects on human health (Ghafoor et al., 2021 ). 4.1. Strengths and limitations This is a comprehensive study with a coverage percentage of 79% (with the presence of 154 countries) that was conducted on a global scale and is remarkably valuable in its way. Another strength was the diversity of the participants there were no criteria for inclusion or exclusion of people in terms of age, gender, race, social, economic, and cultural class to participate in this study. The main limitations of this study were the non-participation of individuals for personal reasons or lack of access to the internet, the drop-out of some countries (41 countries), and background effects such as exposure to various pollutants causing complications such as inflammation and respiratory complications, etc. (Hashemi et al., 2022a ). 5. Conclusion Our findings could serve as a useful source of information in reducing concerns related to the adverse health effects of sanitizers and disinfectant use through education and information by governments and health organizations during viral epidemics. Furthermore, the present results can be helpful for safety and health organizations overseeing the production of chemicals in updating instructions on how to use chemicals, as well as replacing low-risk, low-dose, high-impact chemicals in the production process if possible. Declarations Ethical approval: The study sampling protocol was approved by the Ethics Committee of the Shiraz University of Medical Science (IR.SUMS.REC.1400.023). Consent to participate All the people who participated in this study through an electronic questionnaire; Before answering the questions, they should have chosen the option of informed consent to participate in this research. It is necessary to explain that without choosing the option of informed consent, the participants were not able to enter the other sections of the questionnaire. Consent to publish All authors declare their consent to publish this article. Author contribution and Consent to publish All authors contributed to the study’s conception and design. Data collection was performed by Fallah Hashemi, Lori Hoepner, Farahnaz Soleimani Hamidinejad , , Daniela Haluza, Sima Afrashteh, Alireza Abbasi, Elma Omeragić, Belma Imamović, Narin A. Rasheed , , Taqi Mohammed Jwad Taher, Fitri Kurniasari, Dhuha Youssef Wazqar, Özge Ceren Apalı, Ayca Demir Yildirim, Bo Zhao, Zaruhi Kalikyan, Cui Guo, Andrea Chong Valbuena, Magdalena Mititelu, Carolina Martínez Pando, Maria Saridi, Aikaterini Toska, Magalys Lopez Cuba, Precious Kwablah Kwadzokpui, Niguse Tadele, Tohfa Nasibova, Stefanie Harsch, Luvsan Munkh-Erdene, Wafaa Menawi, Efi Evangelou, Antoniya Dimova, Dimitar Marinov , Teodora Dimitrova , Anna Shalimova, Howieda Fouly, Anna Suraya , , Juliana Pereira da Silva Faquim, Bouadil Oumayma, Maria Antonieta Annunziato, Rezarta Lalo, Evridiki Papastavrou, Anju D. Ade, Susanna Caminada, Svetlana Stojkov, Carmen Gloria Narvaez, lutendo Sylvia Mudau, Ines Rassas, Daphnee Michel, Nur sema Kaynar, Sehar Iqbal, Halla Elshwekh, Irin Hossain, Sadeq AL-Fayyadh Aniuta Sydorchuk, Dua’a Mohammad Hasan Alnusairat Asli Mohamed Abdullahi, Neelam Iqbal, Apsara Pandey, Brenda Gómez-Gómez, Aysenur Gunaydin Akyildiz, Morosan Elena, Daniella Dwarica, Gantuya Dorj, Sumaya Yusuf Hasan, Noha M Al-Shdayfat, Bojana Knezevic, Wendy Valladares, Cecilia Severi, Sofia Cuba Fuentes, Sofia Augusto, Elizaveta Sidorova, Anita Dewi Moelyaningrum, Tafaul Alawad, Atiqa Khalid , , Elehamer Nafisa Mhna Kmbo, Anna Mihaylova, Oxana Tsigengagel, Aziza Menouni, Agnieszka Wojtecka, Rozita Hod, Yusuf Banke Idayat, khadija Othman, Rim M. Harfouch, Tsonco Paunov , Meruyert Omar, Nana Christine Benderli , , Globila Nurika, Sana Amjad, Salma Elnoamany, Fatma Elesrigy, Marwa Mamdouh Shaban, Doménica Acevedo-López, Maria Kartashova, Atika Khalaf , , Sabah Abdullah Jaafar, Taisir A. Kadhim, Nada Ab. Hweissa, Yulong Teng, Fatima Elbasri Abuelgasim Mohammed Yagoub, Thayahlini Sasikumar, Christabel Nangandu Hikaambo, Aditi Kharat, Ulyana Lyamtseva, Maya Arfan Aldeeb , , Natalia Pawlas, Lkhagvasuren Khorolsuren, Roopeshwaree Pallavi Koonjul, Halima Boubacar Maïnassara, Priyanka Chahal, Rose Wangeci W, Ainur B. Kumar, Irina Zamora-Corrales, Stella Gracy, Maimouna Mahamat, Jakub Adamczyk, Haliza Abdul Rahman, Lolita Matiashova, Omneya Ezzat Elsherif, Nazdar Ezzaddin Rasheed Alkhateeb, Yamilé Aleaga, Shima Bahrami, Shaimaa Rahem Al-salihy, Paula Cabrera-Galeana, Mladena Lalic-Popovic, Eugenie Brown-Myrie, Divya Bhandari, Cinderella Akbar Mayaboti, Svetlana Stanišić, Sanda Kreitmayer Pestic, Muhammed Yunus Bektay, Haleama Al Sabbah, Saber Hashemi, Bouchetara Assia, Anne-Sophie Merritt, Zhian Ramzi, Himawatee Baboolal, Juman Isstaif, Rula Shami, Rahma Saad, Temwanani Nyirongo, Mohammad Hoseini . Material preparation by Fallah Hashemi and Mohammad Hoseini , and data analysis by Lori Hoepner and Sima Afrashteh were performed. The first draft of the manuscript was written by Fallah Hashemi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Declaration of competing interest The authors declare that: no budget support, no economic relationship, or any other activity has influenced the process of this research by any organization. Availability of data and materials There is no data to access online. Acknowledgments We are sincerely thankful to the Research Center for Health Sciences, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. 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Cite Share Download PDF Status: Published Journal Publication published 10 May, 2023 Read the published version in Environmental Science and Pollution Research → Version 1 posted Editorial decision: Major Revision 14 Feb, 2023 Reviewers agreed at journal 13 Dec, 2022 Reviewers invited by journal 13 Dec, 2022 Editor assigned by journal 24 Nov, 2022 First submitted to journal 21 Nov, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Renouvelables","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bouchetara","middleName":"","lastName":"Assia","suffix":""},{"id":159782654,"identity":"d7097bff-dc17-463a-b655-ea2695609f06","order_by":133,"name":"Anne-Sophie Merritt","email":"","orcid":"","institution":"Karolinska Institutets folkhälsoakademi: Karolinska Institutet","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anne-Sophie","middleName":"","lastName":"Merritt","suffix":""},{"id":159782655,"identity":"71e718aa-8d80-4349-9d8d-cebcb564331b","order_by":134,"name":"Zhian Ramzi","email":"","orcid":"","institution":"Sulaimani Polytechnic University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhian","middleName":"","lastName":"Ramzi","suffix":""},{"id":159782656,"identity":"15900e6c-a5f8-41b0-b7a9-68f7dd1c3915","order_by":135,"name":"Himawatee Baboolal","email":"","orcid":"","institution":"West Indies School of Theology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Himawatee","middleName":"","lastName":"Baboolal","suffix":""},{"id":159782657,"identity":"c1c72181-dd5c-4758-ab9d-765931dda7d9","order_by":136,"name":"Juman Isstaif","email":"","orcid":"","institution":"Damascus University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juman","middleName":"","lastName":"Isstaif","suffix":""},{"id":159782658,"identity":"c214e078-f90f-4928-9efb-beec1e345fbf","order_by":137,"name":"Rula Shami","email":"","orcid":"","institution":"Qatar University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rula","middleName":"","lastName":"Shami","suffix":""},{"id":159782659,"identity":"0d6a660e-5711-4c78-96fe-5eaa8fa5d3e6","order_by":138,"name":"Rahma Saad","email":"","orcid":"","institution":"Qatar 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04:19:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2267501/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2267501/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11356-023-27197-6","type":"published","date":"2023-05-11T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":30397546,"identity":"30ee74aa-90d0-49bc-9f07-951d7ea0be8f","added_by":"auto","created_at":"2022-12-15 22:53:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22377,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2267501/v1/1cabc2d85d262b31212c6850.png"},{"id":30397549,"identity":"cce0bac6-0251-4b5d-a4bc-1ebade4ea083","added_by":"auto","created_at":"2022-12-15 22:53:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30152,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2267501/v1/098bb392ee96c169eaf622a5.png"},{"id":30397547,"identity":"a569661d-9282-47fb-a267-b006e9076bea","added_by":"auto","created_at":"2022-12-15 22:53:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":917823,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2267501/v1/4cce31e5e50b08cb12c16bd0.png"},{"id":30397548,"identity":"66bc62b2-1a11-487f-b131-91797f73d84b","added_by":"auto","created_at":"2022-12-15 22:53:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":35338,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-2267501/v1/2dc3a845e83a70b43f28f169.png"},{"id":37149799,"identity":"3be7fda9-2536-4327-ae54-fcbd65faa1f6","added_by":"auto","created_at":"2023-05-17 18:08:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1976193,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2267501/v1/fc2bcfbe-4def-42de-817e-030839cf3bbc.pdf"}],"financialInterests":"","formattedTitle":"A Comprehensive Health Effects Assessment of the Use of Sanitizers and Disinfectants during COVID-19 Pandemic: A Global Survey","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCOVID-19 is one of the great challenges to human health. According to the report of the World Health Organization, by November 16, 2022, 548\u0026nbsp;million people were infected and more than 6\u0026nbsp;million deaths worldwide had occurred (WHO, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The emergence of new and mutated strains of the virus over time has exacerbated this catastrophic health challenge (Hashemi et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e). From the beginning of the coronavirus outbreak until now, simultaneously with treatment measures, health and preventive measures such as strict quarantine, social distancing, hand washing, disinfection of various surfaces, and wearing a mask among others, as health protocols to reduce and cutting off the transmission chain were on the agenda of governments and health organizations (Alimohamadi et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e; Amanollahi et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Hashemi et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e). With the hypothesis of the persistence of the virus on different surfaces and its transmission through skin contact, personal and public hygiene by hand washing and disinfection of different surfaces became more important. Among the various surfaces with the most frequent contact were door handles, smartphones, remote controls, keyboards, tables and chairs, light switches, and elevator buttons, etc. (Al-Sayah, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Jin et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Yari et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The literature shows that coronavirus can float in the air for 3 hours, on smooth surfaces (glass, plastic, banknotes) for 4 to 7 days, on the outer layer of the surgical mask for up to 7 days, on copper surfaces, cardboard, and paper for less than 3 hours and stainless steel up to 72 hours (Chin et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Dhama et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Doremalen et al., 2020). The shelf life of the virus depends on various factors such as temperature, relative humidity, and pressure (Dindarloo et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kampf, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). To reduce the spread of the virus and disrupt the transmission chain, disinfection using sanitizers and disinfectants for living and non-living surfaces as an efficient method was recommended by the World Health Organization (WHO) and the US Environmental Protection Agency in accordance with the issued instructions (Chen et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Dindarloo et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Sanitizers and disinfectants used include alcohol-based materials, oxidizing agents, detergents, chlorine-releasing agents (sodium hypochlorite, per-chlorine), phenol-based disinfectants, iodine-releasing agents, aldehydes, hydrogen peroxide, and quaternary ammonium compounds, etc. (Al-Sayah, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; McDonnell and Russell, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Rutala and Weber, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUsing sanitizers and disinfectants may have adverse effects on human health, mainly because of the harmful and corrosive compounds in the composition of most sanitizers and disinfectants, such as chlorine-releasing agents, quaternary ammonium cations, or oxidizing agents (Bonin et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Dumas et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Emmanuel et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Nabi et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The severity of these side effects may vary depending on the type of chemicals, their target objects (living or non-living surfaces), the frequency and volume of the chemicals, and the risk status of the exposed individual (Prajapati et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Lack of knowledge and insufficient experience in sanitizer and disinfectant use increases the rate of side effects due to the use of these chemicals (Gharpure et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Rai et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Potential acute side effects of using sanitizers and disinfectants include skin complications, itching, sore throat, eyes, and nose irritation, and ailments of the respiratory system (cough, sneezing, shortness of breath). Neurological complications such as headache, dizziness, and vomiting have been also reported (ECDC, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Goh et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lachenmeier, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Regardless of the sanitizer and disinfectant safety information and application instructions prolonged use of these products may cause chronic side effects including disorders of the central nervous system (CNS), reproductive disorders, cancer, pulmonary obstruction, etc. (Choi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Although several studies have been conducted regionally in a variety of countries on some of the adverse health effects due to disinfectant use (Dawood et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Dhama et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Dindarloo et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Rosenman et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Shah et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), the current study is a comprehensive survey aimed to estimate the health effects associated with the use of sanitizers and disinfectants among the general population on a global scale.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Design, participants, and sampling procedure\u003c/h2\u003e \u003cp\u003eThis study aims to assess the health effects of sanitizers and disinfectants on a global scale. There were no exclusion/inclusion criteria for participation in the study, and all individuals regardless of race, age, gender, occupation, and income level were included. The research project was approved by the ethics committee of Shiraz University of Medical Sciences. This study follows the principles of the Declaration of Helsinki. Survey design (non-interventional) is not considered a clinical trial under Directive 2001/20/EC and Regulation (Europe) No 536/2014. All participants provided online informed consent before the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Measurement Tools\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1. Questionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire was translated into 26 different languages by native language speakers. The questionnaire includes three parts (including 28 items). The first part (7 questions) was referring to demographic information including age, gender, educational and occupational status, country, place of residence, and income level. The second part (6 questions) includes the type, monthly consumption volume, and the number of daily use of sanitizers and disinfectants for living and non-living surfaces. The chemicals which have been investigated included detergents (Soap and toilet liquid, dishwashing liquid), alcohol or alcohol-based materials, hospital-grade sanitizers (savlon; antiseptic liquid), other commercial sanitizers (chlorhexidine gluconate, bronopol, triclosan), hospital disinfectants (quaternary ammonium, tetra-acetyl ethylenediamine), chlorine-based compounds (sodium hypochlorite, per-chlorine), hydrogen peroxide, and formaldehyde.\u003c/p\u003e \u003cp\u003eThe third part (13 questions) includes health outcomes. Skin complications (itching and skin irritation, dryness, scaling, and urticaria), ocular (itching and eye irritation, and redness), irritation and itching of the throat, respiratory problems (itching and nasal irritation, runny nose, cough and sneezing, and shortness of breath), and neurological effects (headache, dizziness, and vomiting) were questioned. Questionnaire-related questions and options were reviewed by several specialists, including a dermatologist, otolaryngologist, ophthalmologist, pulmonologist, and chemist, as well as a biostatistics specialist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Reliability and Validity\u003c/h2\u003e \u003cp\u003eThe reliability of the questionnaire showed good internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.90). The validity of the questionnaire for only seven living languages ​​(Arabic, English, French, German, Persian, Russian, and Spanish) which are considered official or secondary languages ​​of several countries, was reviewed by 5 to 7 experts with research backgrounds related and faculty members. These experts assessed the validity in light of five components of necessity, relevance, transparency, simplicity, and ambiguity related to each question.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3. Data collection procedure\u003c/h2\u003e \u003cp\u003eThe questionnaire was designed using Google Form\u0026reg;. In some countries (e.g., China), lack of access to Google or due to poor bandwidth, other internal platforms (e.g., wenjuanxing) and sites (e.g.; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) were used to create online links to the questionnaire. The questionnaire was distributed via email or social networks such as Telegram, WhatsApp, Instagram, Twitter, LinkedIn, and WeChat, etc. The questionnaire was available online for 9 months from [Aug 2021] to [Apr 2022] to achieve maximum participation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Statistical analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using IBM SPSS for Windows, version 28.0 (IBM Inc., Armonk, NY). The Chi-square test was used to analyze descriptive statistics (n, %), and to evaluate the significance of the association between variables. To assess risk factors for health outcomes in participants, a multivariable logistic regression analysis was performed, and the relationship between risk factors and adverse effects of using sanitizers and disinfectants are presented as odds ratios (ORs) and 95%CIs, after adjustment for confounders, including age, gender, educational level, occupational status, place of residence (rural and urban areas), and income level. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Study design and participants\u003c/h2\u003e \u003cp\u003eDemographic characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 91056 participants [58 845 (64.6%) females and 32211 (35.4%) males]. Respondents were well represented by ages 21 to 30 years (37577, 41.3%), urban areas (76122, 83.6%), bachelor\u0026rsquo;s degree (38924, 42.7%), and median income (48776, 53.6%). In this study, the income level was considered relative to the average income of each country. Therefore, the majority of participants had an average income in their country. Out of 193 United Nations (UN) members (and 2 countries that are non-member observer states: the Holy See and the State of Palestine), 154 countries participated in this study. The global participation rate was reported to be 79%. 41 countries (21%) from different continents did not participate in the study. According to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the number of participating countries from each continent includes Africa (48), America (19), Asia (44), Europe (39), and Oceania (4) countries correctly completed the questionnaire.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the study (N\u0026thinsp;=\u0026thinsp;91,056)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9861(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3502(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6359(7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21 to 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37577(41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12637(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24940(27.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e31 to 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22250(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8093(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14157(15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e41 to 50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13338(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4744(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8594(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e51 to 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5746(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2150(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3596(3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e60 and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2284(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1085(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1199(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76122(83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25987(28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50135(55.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14934(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6224(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8710(9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSchool education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14784(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5662(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9122(10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12546(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3673(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8873(9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38924(42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13457(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25467(28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16798(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6348(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10450(11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePh.D. and postdoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8004(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3071(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4933(5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eOccupational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnemployed / housewife / student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12571(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2443(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10128(11.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUniversity Student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28104(30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9489(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18615(20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26249(28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10038(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16211(17.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrivate office employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16619(18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e645(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9974(11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFreelance (self-employed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7513(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3596(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3917(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8877(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3004(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5873(6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLower-middle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11339(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4325(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7014(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48776(53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17165(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31611(34.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUpper-middle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18308(20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6276(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12032(13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHigh-income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3756(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1441(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2315(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNumber of participating countries by continent: N (RR*)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfrica\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerica\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOceania\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e(9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003cp\u003e(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo participation: N\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Response Rate\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Type and volume of sanitizers and disinfectants used\u003c/h2\u003e \u003cp\u003eIn the second part of the questionnaire, questions were asked about the type, volume, and number of times of daily use of 5 types of chemical compounds as sanitizers (Fig.\u0026nbsp;1) and 7 types of substances as disinfectants (Fig.\u0026nbsp;2). The status of the use of sanitizers and disinfectants is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Figs.\u0026nbsp;1 to 3. The consumption status of the sanitizers for handwashing or other living surfaces is shown in Fig.\u0026nbsp;1. Compared to other sanitizers, the highest use was detergents (soap and toilet liquid, dishwashing liquid) at 74% (n\u0026thinsp;=\u0026thinsp;67445), and alcohol or non-commercial sanitizers at 57% (n\u0026thinsp;=\u0026thinsp;52083). In contrast, chlorine compounds such as sodium hypochlorite at 10.5% (n\u0026thinsp;=\u0026thinsp;9490) were used less often as sanitizers. Additionally, the status of seven groups of disinfectants, which are used for the disinfection of various high-touch surfaces such as door handles, tables, chairs, remotes, keys, elevator buttons, etc., was explored (Fig.\u0026nbsp;2). In this group, in addition to detergents at 60% (n\u0026thinsp;=\u0026thinsp;54445) and alcohol-based products at 55% (n\u0026thinsp;=\u0026thinsp;49879), which were most used compared to other disinfectants, the use of sodium hypochlorite was reported as a high-consumptive disinfectant at 26% (n\u0026thinsp;=\u0026thinsp;24296). In contrast, formaldehyde by 1.6% (n\u0026thinsp;=\u0026thinsp;1441) and per-chlorine by 7.2% (n\u0026thinsp;=\u0026thinsp;6605) had the lowest consumption as a disinfectant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsumption status of sanitizers and disinfectants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003efrequency of daily use (N/d)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eMonthly consumption volume (CC)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;3/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;6/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003e(\u0026le;\u0026thinsp;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003cp\u003e(101 to 300)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e(301 to 500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eToo much (\u0026ge;\u0026thinsp;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSanitizers\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11069\u003c/p\u003e \u003cp\u003e(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29778\u003c/p\u003e \u003cp\u003e(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27407\u003c/p\u003e \u003cp\u003e(30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21608\u003c/p\u003e \u003cp\u003e(23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1140\u003c/p\u003e \u003cp\u003e(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22849\u003c/p\u003e \u003cp\u003e(25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45091\u003c/p\u003e \u003cp\u003e(49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13292\u003c/p\u003e \u003cp\u003e(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8572\u003c/p\u003e \u003cp\u003e(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1198\u003c/p\u003e \u003cp\u003e(1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMonthly consumption volume (L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;3/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;6/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003e(\u0026le;\u0026thinsp;0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003cp\u003e(0.5 to 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e(1.1 to 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eToo much (\u0026gt;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisinfectants: n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35959\u003c/p\u003e \u003cp\u003e(39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34436\u003c/p\u003e \u003cp\u003e(37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11158\u003c/p\u003e \u003cp\u003e(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5159\u003c/p\u003e \u003cp\u003e(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3990\u003c/p\u003e \u003cp\u003e(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27727\u003c/p\u003e \u003cp\u003e(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44686\u003c/p\u003e \u003cp\u003e(49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10783\u003c/p\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4978\u003c/p\u003e \u003cp\u003e(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2816\u003c/p\u003e \u003cp\u003e(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of use of sanitizers and disinfectants\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDetergents (Soap and toilet liquid, dishwashing liquid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60948 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eAlcohol or alcohol-based materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50984 (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eSodium hypochlorite (bleach)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29020\u003c/p\u003e \u003cp\u003e(32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eHospital-grade sanitizers (savlon)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16892 (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eOther commercial sanitizers (chlorhexidine gluconate, bronopol, triclosan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25091\u003c/p\u003e \u003cp\u003e(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eHospital disinfectants (quaternary ammonium, tetra-acetyl ethylenediamine)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14186 (15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePer-chlorine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6608 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eHydrogen peroxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7380 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFormaldehyde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1444 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn terms of the frequency of daily use of sanitizers and disinfectants, the results showed that most participants tended to use sanitizers and disinfectants 1 to 3 times a day (n\u0026thinsp;=\u0026thinsp;29778, 32.7%) and once a day (n\u0026thinsp;=\u0026thinsp;35959, 39.5%), respectively. The volume of chemicals used was also one of the important factors in creating the scenarios of possible adverse effects and we found that most of the participants stated using the sanitizers and disinfectants at a volume of approximately 101\u0026ndash;300 mL, and 0.5-1 liter per month, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe continental distribution of the inclination of consumers (individuals) to use sanitizers and disinfectants is shown in Fig.\u0026nbsp;3. Four groups of countries were determined according to the sanitizers and disinfectant consumption rate: countries with low consumption (blue\u0026thinsp;\u0026lt;\u0026thinsp;1000), medium consumption (yellow\u0026thinsp;=\u0026thinsp;1001\u0026ndash;2000), high consumption (brown\u0026thinsp;=\u0026thinsp;2001\u0026ndash;3000), and countries that tend to consume too many sanitizers and disinfectants (red\u0026thinsp;\u0026gt;\u0026thinsp;3000). The number of countries that were less inclined to use sanitizers and disinfectants was in Africa, while the number of countries with the highest level of consumption was in Asia. Similarly, the continental distribution shows that most countries with moderate consumption of sanitizers and disinfectants were in continental Europe.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Adverse health outcomes of sanitizers and disinfectants\u003c/h2\u003e \u003cp\u003eThe distribution of the frequency of adverse events showed that the most common complaints reported by the participants were related to skin and respiratory system complications (Fig.\u0026nbsp;4). The highest and lowest frequencies were related to skin dryness by 72% (n\u0026thinsp;=\u0026thinsp;65680) and neurological effects (headache, dizziness, and vomiting) by 14.3% (n\u0026thinsp;=\u0026thinsp;13063), respectively. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the possible adverse health outcomes as a result of the use of sanitizers and disinfectants based on the reports of the participants in this study. There was a significant relationship between the use of chlorine compounds such as sodium hypochlorite and per-chlorine with all the adverse effects (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency table and the relationship between sanitizers/disinfectants and health outcomes (Chi-square test)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of chemical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eItching and Skin Irritation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSkin Dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHand Scaling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eSkin urticaria (Hives)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDetergents (Soap and toilet liquid, dishwashing liquid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29952(32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30996(34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45259(49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15688(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33286(36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27662(30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7037(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e48320(53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol or alcohol-based materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24786(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27300(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39573(43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26110(28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27979(30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24107(26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10614(11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e41472(45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSodium hypochlorite (bleach)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19450(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7443(8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33453(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3440(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29954(32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6940(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4364(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12529(13.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital-grade sanitizers (savlon)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14322(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14698(16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21417(23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7603(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15369(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13651(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6134(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22886(25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOther commercial sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11719(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13372(14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17880(19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7211(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13082(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12009(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5018(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20073(22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital disinfectants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6501(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7685(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10447(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3739(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6943(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7243(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3432(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10754(11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePer-chlorine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4097(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2511(2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5234(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1374(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4581(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2027(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1918(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4690(5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHydrogen peroxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3788(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3592(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5387(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1993(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3925(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3455(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1872(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5508(6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFormaldehyde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e768(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e676(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1000(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e444(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e923(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e521(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e436(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1008(1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCont.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of chemical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eItching and Eye Irritation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eEye Redness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eItching and Throat Irritation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eItching and Nose Irritation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDetergents (Soap and toilet liquid, dishwashing liquid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6294(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44654(49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11255(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49580(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e964(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45754(50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12976(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e37971(41.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol or non-commercial alcohol-based sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14108(15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10309(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9289(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8077(8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12591(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39495(43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19692(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e32394(35.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSodium hypochlorite (bleach)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15407(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11487(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11302(12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12592(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5502(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11391(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17551(19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9342(10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital-grade sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7180 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21840(24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5450(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23570(25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6671(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22349(24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10359(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18661(20.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOther commercial sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6440(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18651(20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4482(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20609(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6035(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19056(20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8911(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16180(17.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital disinfectants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3310(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10876(11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2658(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11528(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2978(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11208(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4530(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9656(10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePer-chlorine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2614(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3994(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1922(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4686(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2624(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3984(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3484(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3124(3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHydrogen peroxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2084(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5296(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1750(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5630(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2049(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5331(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2579(2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4801(5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFormaldehyde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e525(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e919(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e410(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1034(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e482(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e962(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e715(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e729(0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eP-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1. Skin complications\u003c/h2\u003e \u003cp\u003eThe use of detergents and alcohol or alcohol-based products resulted in a greater adverse effect on the skin than other chemicals (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Among the skin complications, the most commonly reported adverse effect was skin dryness. 49.7% (n\u0026thinsp;=\u0026thinsp;45259) and 43.5% (n\u0026thinsp;=\u0026thinsp;39573) of the participants complained of dry skin due to the use of detergents and alcohol or alcohol-based materials, respectively. There was a significant relationship between itching and skin irritation with all chemicals (except other commercial sanitizers and hospital disinfectants) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Unlike other chemicals, there was no significant relationship between skin scaly with alcohols, commercial sanitizers, and hydrogen peroxide (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2. Ocular complications\u003c/h2\u003e \u003cp\u003eThe contribution of sodium hypochlorite in causing ocular complications was greater than other chemicals. Participants reported itching and ocular irritation by 17% (n\u0026thinsp;=\u0026thinsp;15407) and ocular redness by 12.5% (n\u0026thinsp;=\u0026thinsp;11302) after using sodium hypochlorite. The data show a significant relationship between itching and ocular irritation with all sanitizers and disinfectants (except detergents and alcohol or alcohol-based materials) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3. Throat complications\u003c/h2\u003e \u003cp\u003e Participants reported itching and irritation of the throat after using alcohol or alcohol-based products by 13.8% (n\u0026thinsp;=\u0026thinsp;12591), hospital-grade sanitizers such as savlon by 7.3% (n\u0026thinsp;=\u0026thinsp;6671), and other commercial sanitizers by 6.6% (n\u0026thinsp;=\u0026thinsp;6035). Itching and irritation of the throat as one of the possible side effects of sanitizers and disinfectants was significantly associated with some chemicals such as chlorine compounds (sodium hypochlorite \u0026amp; per-chlorine), hospital disinfectants, hydrogen peroxide, formaldehyde (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.3.4. Respiratory system complications\u003c/h2\u003e \u003cp\u003eRespiratory complications including itching and nose irritation by 21.6% (n\u0026thinsp;=\u0026thinsp;19692), runny nose by 13.8% (n\u0026thinsp;=\u0026thinsp;12601), and cough and sneezing by 22.1% (n\u0026thinsp;=\u0026thinsp;20148) were reported after using alcohol or alcohol-based products. There was a significant relationship between shortness of breath with all chemicals except detergents (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, except for chlorine compounds, there was no significant relationship between cough, sneezing, and runny nose with the majority of sanitizers and disinfectants (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.5. Neurological complications\u003c/h2\u003e \u003cp\u003eThe present findings showed that less than eight percent of the participants had self-reported neurological complications including headache, dizziness, and vomiting after using sanitizers and disinfectants. In total, 7.8% (n\u0026thinsp;=\u0026thinsp;7114), and 0.5% (n\u0026thinsp;=\u0026thinsp;419) of participants complained of headaches, dizziness, and vomiting after using alcohol (the most) and formaldehyde (the least), respectively. The results indicated that a statistically significant relationship was found between possible neurological problems due to the use of analyzed sanitizers and disinfectants (except detergents) (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Multivariable logistic regression analysis\u003c/h2\u003e \u003cp\u003eAfter controlling for confounders (demographic characteristics), a multivariable logistic regression analysis was performed to determine the risk factors associated with adverse health outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The use of some sanitizers and disinfectants was associated with skin adverse effects (e.g., Itching and skin irritation after using alcohol or alcohol-based materials: OR, 1.86; 95%CI, p\u0026thinsp;\u0026gt;\u0026thinsp;0.001; or as a result of using sodium hypochlorite: OR, 1.43; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, the use of some other sanitizers and disinfectants was associated with a lower chance of itching and skin irritation (hospital disinfectants: OR, 0.91; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The use of Per-chlorine (OR, 1.47; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), alcohol-based materials (OR, 1.98; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), formaldehyde (OR, 1.40; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with higher odds of skin dryness, scaling of the skin, skin urticaria respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk Factors for Health complications by Multivariable Logistic Regression Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of chemical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eItching and Skin Irritation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eSkin Dryness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eSkin scaling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eSkin urticaria (Hives)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetergents (Soap and toilet liquid, dishwashing liquid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u0026ndash;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.02\u0026ndash;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.11\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.90\u0026ndash;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol or alcohol-based materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u0026ndash;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.26\u0026ndash;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.87\u0026ndash;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.83\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium hypochlorite (bleach)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026ndash;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.35\u0026ndash;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.24\u0026ndash;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.87\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-grade sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.98\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.83\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther commercial sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.83\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.92\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.79\u0026ndash;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital disinfectants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u0026ndash;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.06\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.81\u0026ndash;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.21\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer-chlorine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.38\u0026ndash;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.29\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.90\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrogen peroxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u0026ndash;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.90\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.91\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.29\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormaldehyde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07\u0026ndash;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76\u0026ndash;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.31\u0026ndash;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.24\u0026ndash;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"13\" nameend=\"c13\" namest=\"c1\"\u003e \u003cp\u003eAdjusted for age, sex, educational level, occupational status, place of residence (rural \u0026amp; city), and income level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCont.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of chemical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eItching and Eye Irritation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eEye Redness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eItching and Throat Irritation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e \u003cp\u003eItching and Nose Irritation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eCI (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetergents (Soap and toilet liquid, dishwashing liquid)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.82\u0026ndash;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.62\u0026ndash;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.17\u0026ndash;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol or alcohol-based materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.01\u0026ndash;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.93\u0026ndash;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.04\u0026ndash;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium hypochlorite (bleach)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026ndash;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.58\u0026ndash;1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.58\u0026ndash;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.41\u0026ndash;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-grade sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u0026ndash;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.86\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.81\u0026ndash;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.84\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther commercial sanitizers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026ndash;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.77\u0026ndash;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.86\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.82\u0026ndash;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital disinfectants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026ndash;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.79\u0026ndash;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.79\u0026ndash;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer-chlorine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026ndash;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.68\u0026ndash;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e2.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.90\u0026ndash;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.78\u0026ndash;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrogen peroxide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u0026ndash;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.40\u0026ndash;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.13\u0026ndash;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.87\u0026ndash;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormaldehyde\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.26\u0026ndash;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.19\u0026ndash;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.15\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.40\u0026ndash;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eAdjusted for age, sex, educational level, occupational status, place of residence (rural \u0026amp; city), and income level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eItching and ocular irritation were reported after using per-chlorine: OR, 1.83; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; and sodium hypochlorite: OR, 1.33; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Similarly, ocular redness was associated with the use of per-chlorine (OR, 1.77; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and hydrogen peroxide (OR, 1.49; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe results showed that one of the important risk factors for throat-related effects is chlorine-based compounds. Per-chlorine resulted in double the risk for throat-related effects (OR, 2.00; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sodium hypochlorite use is also a serious risk factor for itching and throat irritation (OR, 1.66; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the use of sodium hypochlorite (OR, 1.74; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and formaldehyde (OR, 1.56; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were accompanied by coughing and sneezing. Similarly, shortness of breath was associated with the use of sodium hypochlorite (OR, 1.78; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and per-chlorine (OR, 1.67; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was a strong association between the use of formaldehyde and the occurrence of neurological complications (OR, 2.17; 95%CI, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eRegarding the use of sanitizers and disinfectants in different continents, it was observed that in African countries, due to low-income levels, and lack of accessibility the tendency to use disinfectants was lower than in other continents. In contrast, in some less-resourced countries, such as Iran, and more-resourced countries, such as China, the US, the UK, Germany, and Australia, etc., there was a greater tendency to use disinfectants. Adequate income levels, adequate education, and information, easy access to the types of sanitizers and disinfectants, and strict controlling measures by the governments have been effective in increasing the use of these chemicals (Becher et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Bu et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tran et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Unruh et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Xu et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Although our claim regarding some countries such as Venezuela, Iraq, Afghanistan, etc. was not correct. Contrary to the economic crisis prevailing in these countries, the use of sanitizers and disinfectants was high.\u003c/p\u003e \u003cp\u003eIn addition to this more attention and the fear of contracting the disease, sometimes leads to the excessive consumption of sanitizers and disinfectants, which leads to the occurrence of adverse effects due to the toxic nature of these chemicals on the population; finally, the body's resistance to other infectious agents may decrease (Tachikawa, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Vogel, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). On the other hand, the denial of the existential nature of the COVID-19 disease by people from different countries (Afolabi and Ilesanmi, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Buguzi, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Cabral et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Thagard, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) can be one of the main reasons for not tending to use sanitizers and disinfectants as part of health protocols. We found that the disinfectants with the highest rate of causing different adverse health effects are chlorine compounds (sodium hypochlorite and per-chlorine). One of the reasons for this finding could be the widespread use of these compounds as bleaches, cleansers, and vegetable washes, for washing different surfaces, water disinfection as well as easy access and affordability. In addition to the inherent complications of using chemicals as sanitizers and disinfectants, there are other reasons such as misuse (mixing several chemicals without following the instructions), excessive use, and counterfeit and unauthorized products that can cause side effects (Alhouri et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Cook and Brooke, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, some disinfectants (e.g., detergents) may not have serious adverse effects on human health, but prolonged exposure and overuse of any chemical increase their harmful potential (Baldeo et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Similar studies have shown that most disinfectants, such as alcohols and proxygene compounds, can be considered potential irritants or skin allergens (Goh et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lachenmeier, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Murphy and Friedman, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The US centers for disease control and prevention (CDC) reported an increase in calls to the center because of overuse and frequent exposure to cleaning chemicals during the Covid-19 pandemic (CDC, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Rosenman et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious reports have claimed that long-term use of surfactants causes dryness and roughness of the skin (Goh et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Paudel et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shibuya et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Similarly, alcohol-based substances despite their low permeability to the skin had the most skin effects as a result of prolonged contact and regular and continuous use. Similar studies have reported increased exposure and frequency of alcohol use as a cause of skin irritation or dermatitis (Bouthoorn et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lachenmeier, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Unlike sanitizers and other disinfectants, alcohols were more effective in causing skin urticaria. In one study, skin urticaria was reported as a result of alcohol use (such as isopropanol) due to the combination of these alcohols with some solvents and organic matter (Berardi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Goh and Ahmed, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Pecquet et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1992\u003c/span\u003e). The results obtained in this study regarding skin complications were in accordance with some scientific texts and similar studies (Bito et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Chan and Maibach, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Europe, 2017; Murphy and Friedman, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The results of the multivariate regression analysis showed that detergents, alcohols or alcohol-based substances, and chlorine compounds have a higher potential of causing skin complications compared to other sanitizers and disinfectants.\u003c/p\u003e \u003cp\u003eOcular complications (itching and irritation and eye redness) due to the use of sanitizers and disinfectants were less common than other complications. However, in terms of frequency, detergents and alcohol accounted for the largest share of ocular side effects. The results of some studies confirm our findings that itching and eye irritation are a result of the use of alcohol as a sanitizer/disinfectant (Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Statistical results showed that among the chemicals studied, chlorine compounds had a higher chance of causing ocular complications compared to other disinfectants. This is probably due to the wide range of applications of chlorine compounds for different purposes as well as their ability to be mixed with other solvents. Studies have shown that the use of chlorine-based compounds in the form of sprays to disinfect surfaces will cause itching and eye irritation (Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Schyllert et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; WHO, 2020). Since people used several types of chemicals separately or mixed to wash hands, face, and feet or to disinfect different surfaces, improper mixing of chemicals may release toxic gases and vapors that can affect the respiratory system. Studies have shown that mixing bleach with acidic cleaning agents leads to the release of highly irritating gases (PHE, 2015; Racioppi et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). Rosenman et al. claimed that not following hygienic instructions on how to use or mix cleansing products with other chemicals such as acid would create the conditions for chemical pneumonia or pulmonary edema (Rosenman et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Our findings showed that chlorine compounds (sodium hypochlorite and per-chlorine) were involved in causing all complications related to the respiratory system. This claim was consistent with a list approved by the US Environmental Protection Agency (Alimohamadi et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e) that sodium hypochlorite is an irritant and allergen for the respiratory system (EPA, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The results of multivariate regression analysis showed that formaldehyde had an immensely significant chance of causing neurological effects compared to other sanitizers and disinfectants. Formaldehyde, as a carcinogen by OSHA (Tarka et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), has an unpleasant odor and is an irritant that can cause many adverse effects on human health (Ghafoor et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Strengths and limitations\u003c/h2\u003e \u003cp\u003eThis is a comprehensive study with a coverage percentage of 79% (with the presence of 154 countries) that was conducted on a global scale and is remarkably valuable in its way. Another strength was the diversity of the participants there were no criteria for inclusion or exclusion of people in terms of age, gender, race, social, economic, and cultural class to participate in this study. The main limitations of this study were the non-participation of individuals for personal reasons or lack of access to the internet, the drop-out of some countries (41 countries), and background effects such as exposure to various pollutants causing complications such as inflammation and respiratory complications, etc. (Hashemi et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur findings could serve as a useful source of information in reducing concerns related to the adverse health effects of sanitizers and disinfectant use through education and information by governments and health organizations during viral epidemics. Furthermore, the present results can be helpful for safety and health organizations overseeing the production of chemicals in updating instructions on how to use chemicals, as well as replacing low-risk, low-dose, high-impact chemicals in the production process if possible.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sampling protocol was approved by the Ethics Committee of the Shiraz University of Medical Science (IR.SUMS.REC.1400.023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the people who participated in this study through an electronic questionnaire; Before answering the questions, they should have chosen the option of informed consent to participate in this research. \u0026nbsp;It is necessary to explain that without choosing the option of informed consent, the participants were not able to enter the other sections of the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare their consent to publish this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study\u0026rsquo;s conception and design. Data collection was performed by\u0026nbsp;Fallah Hashemi, Lori Hoepner, Farahnaz Soleimani Hamidinejad\u003csup\u003e,\u003c/sup\u003e, Daniela Haluza,\u003csup\u003e\u0026nbsp;\u003c/sup\u003eSima Afrashteh, Alireza Abbasi, Elma Omeragić, Belma Imamović, Narin A. Rasheed\u003csup\u003e,\u003c/sup\u003e, Taqi Mohammed Jwad Taher, Fitri Kurniasari, Dhuha Youssef Wazqar, \u0026Ouml;zge Ceren Apalı, Ayca Demir Yildirim, Bo Zhao, Zaruhi Kalikyan, Cui Guo, Andrea Chong Valbuena, Magdalena Mititelu, Carolina Mart\u0026iacute;nez Pando, Maria Saridi, Aikaterini Toska, Magalys Lopez Cuba, Precious Kwablah Kwadzokpui, Niguse Tadele, Tohfa Nasibova, Stefanie Harsch, Luvsan Munkh-Erdene, Wafaa Menawi, Efi Evangelou, Antoniya Dimova,\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\u003eDimitar Marinov\u003c/a\u003e,\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\u003eTeodora Dimitrova\u003c/a\u003e, Anna Shalimova, Howieda Fouly, Anna Suraya\u003csup\u003e,\u003c/sup\u003e, \u0026nbsp;Juliana Pereira da Silva Faquim, Bouadil Oumayma, Maria Antonieta Annunziato, Rezarta Lalo, Evridiki Papastavrou, Anju D. Ade, Susanna Caminada, Svetlana Stojkov, Carmen Gloria Narvaez, lutendo Sylvia Mudau, Ines Rassas, Daphnee Michel, Nur sema Kaynar, Sehar Iqbal, Halla Elshwekh, Irin Hossain, Sadeq AL-Fayyadh Aniuta Sydorchuk, Dua\u0026rsquo;a Mohammad Hasan Alnusairat Asli Mohamed Abdullahi, Neelam Iqbal, Apsara Pandey, Brenda G\u0026oacute;mez-G\u0026oacute;mez, Aysenur Gunaydin Akyildiz, Morosan Elena, Daniella Dwarica, Gantuya Dorj, Sumaya Yusuf Hasan, Noha M Al-Shdayfat, Bojana Knezevic, Wendy Valladares, Cecilia Severi, Sofia Cuba Fuentes, Sofia Augusto, Elizaveta Sidorova, Anita Dewi Moelyaningrum, Tafaul Alawad, Atiqa Khalid\u003csup\u003e,\u003c/sup\u003e, Elehamer Nafisa Mhna Kmbo, Anna Mihaylova, Oxana Tsigengagel, Aziza Menouni, Agnieszka Wojtecka, Rozita Hod, Yusuf Banke Idayat, khadija Othman, Rim M. Harfouch,\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\u003eTsonco Paunov\u003c/a\u003e, Meruyert Omar, Nana Christine Benderli\u003csup\u003e,\u003c/sup\u003e, Globila Nurika, Sana Amjad, Salma Elnoamany, Fatma Elesrigy, Marwa Mamdouh Shaban, Dom\u0026eacute;nica Acevedo-L\u0026oacute;pez, Maria Kartashova, Atika Khalaf\u003csup\u003e,\u003c/sup\u003e, Sabah Abdullah Jaafar, Taisir A. Kadhim, Nada Ab. Hweissa, Yulong Teng, Fatima Elbasri Abuelgasim Mohammed Yagoub, Thayahlini Sasikumar, Christabel Nangandu Hikaambo, Aditi Kharat,\u0026nbsp;Ulyana Lyamtseva,\u0026nbsp;Maya Arfan Aldeeb\u003csup\u003e,\u003c/sup\u003e, Natalia Pawlas, Lkhagvasuren Khorolsuren, Roopeshwaree Pallavi Koonjul, Halima Boubacar Ma\u0026iuml;nassara, Priyanka Chahal, Rose Wangeci W, Ainur B. Kumar, Irina Zamora-Corrales, Stella Gracy, Maimouna Mahamat, Jakub Adamczyk, Haliza Abdul Rahman, Lolita Matiashova, Omneya Ezzat Elsherif, Nazdar Ezzaddin Rasheed Alkhateeb,\u0026nbsp;Yamil\u0026eacute; Aleaga,\u0026nbsp;Shima Bahrami, Shaimaa Rahem Al-salihy, Paula Cabrera-Galeana, Mladena Lalic-Popovic, Eugenie Brown-Myrie, Divya Bhandari, Cinderella Akbar Mayaboti, Svetlana Stani\u0026scaron;ić, Sanda Kreitmayer Pestic,\u0026nbsp;Muhammed Yunus Bektay, Haleama Al Sabbah, Saber Hashemi, Bouchetara Assia, Anne-Sophie Merritt, Zhian Ramzi,\u0026nbsp;Himawatee Baboolal, Juman Isstaif, Rula Shami, Rahma Saad, Temwanani Nyirongo,\u0026nbsp;\u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0045653522011432?via%3Dihub#!\"\u003eMohammad Hoseini\u003c/a\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMaterial preparation by Fallah Hashemi and\u0026nbsp;\u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0045653522011432?via%3Dihub#!\"\u003eMohammad Hoseini\u003c/a\u003e, and data analysis by Lori Hoepner and Sima Afrashteh were performed. The first draft of the manuscript was written by Fallah Hashemi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that: no budget support, no economic relationship, or any other activity has influenced the process of this research by any organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no data to access online.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are sincerely thankful to the Research Center for Health Sciences, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. We also gratefully acknowledge the KHARKIV NATIONAL MEDICAL UNIVERSITY and the esteemed president of that university, Dr. Valeriy Kapustnik, for their cooperation in uploading the electronic link of the questionnaire on the university\u0026apos;s website.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAfolabi AA, Ilesanmi OS. Dealing with vaccine hesitancy in Africa: the prospective COVID-19 vaccine context. The Pan African Medical Journal 2021; 38.\u003c/li\u003e\n\u003cli\u003eAl-Sayah MH. Chemical disinfectants of COVID-19: an overview. Journal of water and health 2020; 18: 843-848.\u003c/li\u003e\n\u003cli\u003eAlhouri A, Salloum A, Harfouch RM, Soumya G. Possible side effects of using detergents during the Covid19 pandemic in Syria. Ann. Clin. Cases 2020; 1: 1023.\u003c/li\u003e\n\u003cli\u003eAlimohamadi Y, Sepandi M, Rashti R, Nezhad HS, Afrashteh S. 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Cleaning and disinfection of environmental surfaces in the context of COVID-19: interim guidance.\u0026nbsp; 2020; 15 May 2020: World Health Organization.\u003c/li\u003e\n\u003cli\u003eWHO. WHO Coronavirus (COVID-19) Dashboard. The World Health Organization 2022.\u003c/li\u003e\n\u003cli\u003eXu W, Wu J, Cao L. COVID-19 pandemic in China: Context, experience and lessons. Health policy and technology 2020; 9: 639-648.\u003c/li\u003e\n\u003cli\u003eYari S, Moshammer H, Asadi AF. Side effects of using disinfectants to fight COVID-19. Asian Pacific Journal of Environment and Cancer 2020; 3: 9-13.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"environmental-science-and-pollution-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"espr","sideBox":"Learn more about [Environmental Science and Pollution Research](https://www.springer.com/journal/11356)","snPcode":"11356","submissionUrl":"https://submission.nature.com/new-submission/11356/3","title":"Environmental Science and Pollution Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"COVID-19, sanitizers and disinfectants, side effects, health protocols","lastPublishedDoi":"10.21203/rs.3.rs-2267501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2267501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCOVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91056 participants from 154 countries participated in this cross-sectional study through an electronic questionnaire. Results implied that detergents (67%), alcohol-based materials (56%), and chlorinated compounds (32%) were the most commonly used types of sanitizers and disinfectants. Most frequently reported health issues include skin complications 48.8% and respiratory complications 29.8%. The Chi-square test showed a significant association between chlorinated compounds with all possible health complications under investigation (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Examination of risk factors based on multivariate regression analysis showed that alcohols-based materials were associated with skin complications (OR, 1.98; 95%CI, 1.87\u0026ndash;2.09), per-chlorine was associated with eye complications (OR, 1.83; 95%CI, 1.74\u0026ndash;1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90\u0026ndash;2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological complications (OR, 2.17; 95%CI, 1.92\u0026ndash;2.44). The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics.\u003c/p\u003e","manuscriptTitle":"A Comprehensive Health Effects Assessment of the Use of Sanitizers and Disinfectants during COVID-19 Pandemic: A Global Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-12-15 22:53:42","doi":"10.21203/rs.3.rs-2267501/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revision","date":"2023-02-14T16:07:04+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2022-12-13T14:25:07+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-12-13T14:20:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-11-25T04:14:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Environmental Science and Pollution Research","date":"2022-11-21T05:38:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"environmental-science-and-pollution-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"espr","sideBox":"Learn more about [Environmental Science and Pollution Research](https://www.springer.com/journal/11356)","snPcode":"11356","submissionUrl":"https://submission.nature.com/new-submission/11356/3","title":"Environmental Science and Pollution Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"edcb37ce-8f39-4730-85d6-f37c4594191d","owner":[],"postedDate":"December 15th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-05-17T18:08:01+00:00","versionOfRecord":{"articleIdentity":"rs-2267501","link":"https://doi.org/10.1007/s11356-023-27197-6","journal":{"identity":"environmental-science-and-pollution-research","isVorOnly":false,"title":"Environmental Science and Pollution Research"},"publishedOn":"2023-05-11 00:00:00","publishedOnDateReadable":"May 11th, 2023"},"versionCreatedAt":"2022-12-15 22:53:42","video":"","vorDoi":"10.1007/s11356-023-27197-6","vorDoiUrl":"https://doi.org/10.1007/s11356-023-27197-6","workflowStages":[]},"version":"v1","identity":"rs-2267501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2267501","identity":"rs-2267501","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}