Second-hand Smoke Exposure Among Home Care Workers (HCWs) in Scotland

Second-hand tobacco smoke (SHS) is a serious cause of ill-health, and concern around SHS exposure at work has driven legislation in public places. In Scotland, most workers are now protected from SHS at work. However, home care workers (HCWs) may still be exposed, as they enter private homes where smoking is unregulated. In this study, we aimed to understand the extent, duration and intensity of that exposure among HCWs in Lanarkshire, Scotland.

We surveyed HCWs in four organisations involved in providing care at home: a public healthcare agency (NHS Lanarkshire), two local government entities and a private healthcare company. We also conducted personal exposure monitoring (PEM) of exposure to airborne nicotine and SHS-related fine particulate matter (PM2.5) with 32 HCWs.

The vast majority of HCWs surveyed reported being exposed to SHS at work (395/537, 74%), and 50% of those who reported exposure in the home indicated daily exposure. We conducted PEM over 82 home visits, with 21% (17) demonstrating PM2.5 concentrations in excess of the WHO's 2010 air quality guideline limit for 24 h exposure. Duration of exposure to SHS tended to be short and as a result all nicotine samples were below the limit of quantification.

Most HCWs are exposed to minimal levels of SHS at work. However, a minority may be exposed to concentrations which affect health. Policies to mitigate this exposure should be considered, such as the use of respiratory protective equipment, improved ventilation during visits, and interventions to reduce smoking in homes.