text: VOCs are also found in hospital and health care environments. In these settings, these chemicals are widely used for cleaning, disinfection, and hygiene of the different areas. Thus, health professionals such as nurses, doctors, sanitation staff, etc., may present with adverse health effects such as asthma; however, further evaluation is required to determine the exact levels and determinants that influence the exposure to these compounds.
  Studies have shown that the concentration levels of different VOCs such as halogenated and aromatic hydrocarbons differ substantially between areas of the same hospital. However, one of these studies reported that ethanol, isopropanol, ether, and acetone were the main compounds in the interior of the site. Following the same line, in a study conducted in the United States, it was established that nursing assistants are the most exposed to compounds such as ethanol, while medical equipment preparers are most exposed to 2-propanol.
  In relation to exposure to VOCs by cleaning and hygiene personnel, a study conducted in 4 hospitals in the United States established that sterilization and disinfection workers are linked to exposures to d-limonene and 2-propanol, while those responsible for cleaning with chlorine-containing products are more likely to have higher levels of exposure to α-pinene and chloroform. Those who perform floor and other surface cleaning tasks (e.g., floor waxing) and who use quaternary ammonium, alcohol, and chlorine-based products are associated with a higher VOC exposure than the two previous groups, that is, they are particularly linked to exposure to acetone, chloroform, α-pinene, 2-propanol or d-limonene.
  Other healthcare environments such as nursing and age care homes have been rarely a subject of study, even though the elderly and vulnerable populations may spend considerable time in these indoor settings where they might be exposed to VOCs, derived from the common use of cleaning agents, sprays and fresheners. In a study conducted in France, a team of researchers developed an online questionnaire for different social and age care facilities, asking about cleaning practices, products used, and the frequency of these activities. As a result, more than 200 chemicals were identified, of which 41 are known to have adverse health effects, 37 of them being VOCs. The health effects include skin sensitization, reproductive and organ-specific toxicity, carcinogenicity, mutagenicity, and endocrine-disrupting properties. Furthermore, in another study carried out in the same European country, it was found that there is a significant association between breathlessness in the elderly population and elevated exposure to VOCs such as toluene and o-xylene, unlike the remainder of the population.