Although the cleaning sector is developing into an important part of the European economy, the cleaners themselves are adversely affected by a number of factors: low perception and self-perception, strenuous manual work, MSDs, use of a large variety of chemicals, exposure to biological hazards, high risk of accident (e.g. slips, trips, falls from ladders, sharps), communication problems (subcontracting, different places of work, high percentage of immigrants), violence, working alone or out of hours, and psychosocial issues. A modern, comprehensive approach is required to tackle these issues; it must involve the workers, applying new concepts such as ‘moving with awareness’.
Cleaners
Definition
The Brussels-based European Federation of Cleaning Industries carries out surveys for the sector every two years. Until January 2008, the ‘cleaning industry’ was defined by NACE classification – REV. 1 [1]. In revision 2 of the NACE code, cleaning is defined as a sub-sector in section N "Administrative and support service activities", class 81.2 "Cleaning activities" which includes [2]:
81.21 “General cleaning of buildings"
81.22 “Other building and industrial cleaning activities"
81.29 “Other cleaning activities".
Cleaning is a generic job – it is carried out in all industry groups, institutions, and households, outside and inside, including public areas. Cleaners are thus better defined by task rather than sector. They may be called cleaners, housekeepers, chars, caretakers or janitors, depending on the spaces cleaned and assigned tasks. For example, janitors and caretakers may combine cleaning with maintenance and repair work [3]. Common tasks are surface cleaning, including mopping, dusting, vacuuming, polishing of floors and work surfaces, and routine housekeeping including disposing of waste and waste water. There are also specialists, such as window cleaners, façade cleaners, industrial cleaners (including food processing industry, clean rooms, ships, public transport), cleaners for critical rooms and equipment in healthcare, and cleaners who deal with catastrophes (e.g. fires, flooding).
Economic relevance
Cleaners help extend the life of buildings, plants, machines, equipment, and furniture. The hygienic aspects are also important, as proper cleaning can prevent diseases. This applies especially to hospitals, healthcare facilities, kindergartens, schools, public transport services, public offices, agriculture, food processing, and anywhere generally that people meet, where diseases could be spread [4].
According to the EFCI survey, the cleaning sector in Europe has seen continuous and significant growth over the past 20 years. There was a fivefold increase in turnover from 1989 to 2008 [1]. Industrial cleaning represents one of the most dynamic areas of corporate services, with more than 158,000 cleaning contractors across Europe, generating a turnover of nearly 62 billion EUR [1][5].
In 2008, more than 3.75 million people were employed in the cleaning industry in the member state countries, representing an increase of 5% over two years. However, some of these jobs may have shifted from other sectors that have outsourced cleaning services [5].
Specialities
Rationalisation
The sector has seen a trend of increasing rationalisation: Wages are the highest cost in this labour-intensive sector, so this is where competition is toughest. With fairly comprehensive or generally binding collective agreements, competition on wages mainly revolves around getting people to do the same work in less time, which leads to a spiral of lower incomes and greater work intensity [5].
Subcontracting
Cleaners may be independent, employed by the company owning the facility, or work for private contractors. Rationalisation has had an impact on the occupational safety and health of workers, particularly with regard to increasing competition and subcontracting in the sector.
Contract awarding, procurement
Companies must submit tenders to provide outsourced cleaning services (public procurement in the case of public clients). To ensure the quality of the work, other criteria than price must be taken into account, otherwise it will also lead to lower incomes and increasing work intensity [5].
Company structure
While there are large companies in the field, the cleaning sector is mainly composed of small and very small companies. There are also many self-employed cleaners. In 2006, about 89% of the cleaning companies had less than 50 employees and only 11% had more than 50 employees [2].
Worker contracts
About 70% of EU workers in the sector work part-time [2].
Gender
Another characteristic of the sector is the high proportion of women: In 2003, 77% of cleaners were women [2].
Immigrants, ethnic minorities
A high proportion of cleaners are migrant workers and workers from ethnic minorities [4].
Working time
Generic cleaning is usually performed outside normal working hours, either in the early morning or evening, so that work in the offices and workshops is not disturbed. This restricts the family life of such cleaning workers.
Work areas
Subcontracted cleaners may be deployed at unfamiliar workplaces, and often several workplaces must be visited and cleaned, sometimes in one shift. Cleaning may be done in confined spaces with little ventilation, or in spaces not designed with cleaning in mind [5].
Undeclared work, domestic workers
In private households, cleaners are generally self-employed. However, these activities are often undeclared, meaning that they are not known to the authorities. Many ‘illegally’ employed workers - who do not comply with national laws - are found in these cleaning jobs, such as immigrant workers who are in the country on an illegal basis, or do not have the right to work [2].
Hazards and risks
Cleaners should be adequately qualified to meet quality and hygiene standards, e.g. in hospitals and food processing factories. However, cleaners may suffer from low self-esteem at work. This can be ascribed to their ‘invisibility’ - i.e. working outside normal office hours and the feeling that they are a disturbance to the usual work processes. They deal with waste substances, and often have to accept low salaries and precarious working conditions. Exposure to these hazards and risks, can lead to accidents and work-related diseases [4].
Illustration: screen shots from NAPO film Clean Sweep
Source: Napo films
Chemical factors
Cleaning workers may be exposed to a broad range of different chemicals:
Cleaning products for dirt removal, disinfectants, polish, e.g. organic solvents, surfactants, film formers (such as wax), complexing agents (e.g. EDTA), acids, alkalines, pigments and fragrances.
Substances contained in the dirt, which can become airborne and can be inhaled during cleaning, such as oils, greases, surfactants, quartz, minerals, and other inorganic substances (e.g. trace metals), soot.
Due to environmental and financial reasons, cleaning agents may be delivered in high concentrations, and these may be corrosive, e.g. acids or bases. Moreover, over-dosage, mixing or incorrectly using products may create unexpected chemical reactions and release dangerous substances. Chemicals may cause breathing problems if over sprayed, used without adequate ventilation, or sprayed onto hot surfaces. Skin can be affected by wet work [3][2].
Depending on the chemicals, health outcomes range from irritation of the eyes and mucous membranes, skin dermatitis, respiratory disorders (e.g. asthma), effects on the central nervous system, cancers, and reproductive problems for both males and females including pregnant women. Cleaning agents, aerosols, and dust may also be flammable or explosive [3][2][6].
Physical factors
Physical hazards encountered in cleaning work include wet and slippery floors, working at height, falling objects, sharp objects, and moving or rotating machinery parts (both from equipment and in the workplace generally). These can cause slips, trips, and falls accidents, as well as cuts and bruises [2][6].
Cleaning work is physically demanding and strenuous for the musculoskeletal and cardiorespiratory systems. Cleaners often work in awkward postures, bent forward and with twisted backs, because of poor ergonomic characteristics of the cleaning equipment or the work environment (e.g. confined spaces). At the same time, they might have to lift heavy pieces of furniture or work equipment. They may perform a high number of repetitive movements, which sometimes require ‘elbow grease’ - the application of high forces, e.g. when scrubbing. They often lack training on ergonomics. This combination of factors puts them at high risk of developing musculoskeletal disorders (MSDs) [6][7].
The use of vibrating equipment can reinforce negative effects of physical strain such as awkward postures and handling heavy loads, and can lead to MSDs, numbness in the limbs, and neurological disorders in the hand-arm system (carpal tunnel syndrome, white finger syndrome) [7].
Some cleaning machines produce noise levels that are stressful for cleaners, especially when several such machines are used at once, even leading to collisions and accidents when they cover the sound of approaching people or vehicles. Sources of electrical hazards include electrical tools and equipment, appliances, wiring, switch panels and electrical outlets or transformers. Damage to cables is not uncommon for high risk equipment such as rotary disc machines [2].
Heat stress can occur in hot environments, e.g. when cleaning in restaurant kitchens, washing rooms, etc. Working in hot and humid atmospheres can result in heat rash, intertrigo (chafing), skin maceration, and supervening bacterial or fungal infection, especially in overweight and diabetic individuals. Direct contact of the skin with external heat sources such as hot objects/surfaces can result in occupational thermal injuries e.g. contact burns and heat urticaria. Conversely, work may be performed in cold conditions (outside, cold stores, etc.) [2].
In the healthcare sector, cleaning and maintenance staff may be at risk of exposure to high levels of static magnetic fields inside Magnetic Resonance Imaging (MRI) rooms, or inside the bore of the magnet. The static field is permanently present (sometimes very high intensity), even when the MRI is not in use. Cleaners may also be exposed to static magnetic fields from Nuclear Magnetic Resonance spectroscopy (NMR), where the magnet capacity is generally higher than for MRI scans. Several of these physical factors represent reprotoxic risks for both males and females (including pregnant women) [2][8].
Biological factors
Cleaning workers can also be exposed to different types of biological agents, such as micro-organisms (bacteria, viruses and moulds) and their by-products, such as fungal secretions and bacterial endotoxins present in dust as well as in aerosols created during cleaning, including vacuum cleaning. The exposure routes are the same as for chemical hazards, i.e. mainly inhalation and dermal uptake, and occasionally ingestion. Cleaning workers may also be exposed to blood-borne pathogens - in particular in the healthcare sectors and in public places, where they may come in contact with contaminated needles and sharps. They may also be exposed to pathogens contained in body fluids. There is also a risk associated with contact with animals (e.g. pets, rodents and birds) and their secretion/droppings, as well as with insects (e.g. mosquitoes). HIV and hepatitis B (HBV) or C (HCV) are the most common risks. HIV causes AIDS and the hepatitis viruses cause inflammations of the liver. Connections between cleaning activities and infection with Hepatitis A virus and Noroviruses have also been identified [4].
Several of these biological factors represent reprotoxic risks for both males and females including pregnant women [8].
Psychosocial factors
Many factors (e.g. time pressure and a high demand for flexibility due to varying workplaces) increase stress and stress related diseases, such as cardiovascular, digestion and immune problems [2].
Emerging and newly detected risks
Several products contain nanomaterials because they provide enhanced properties [9]. Sometimes manufacturers merely claim that their products contain such materials for advertising purposes, as tests have shown [10]. Cleaning agents sometimes contain nanomaterials that are supposed to give surfaces self-cleaning properties. Some may contain nano-silver because of its disinfecting properties [10]. Nano-silver in higher concentrations can cause skin problems, Other observed effects of nanomaterials include inflammation, fibrosis and lung tumours [11]. However, more research is needed to fully understand the effects of the various nanomaterials [11].
Research has found new health risks in so called endocrine disrupting chemicals (EDCs), such as pesticides, heavy metals, flame retardants, plasticisers, anaesthetic gases, and surfactants (nonylphenol). Cleaners may be exposed to dust containing flame retardants, to anaesthetics (when cleaning in hospitals or medical practices), and surfactants in cleaning agents, all of which represent reprotoxic risks. These substances may already show effects at very low concentrations, and sometimes long after exposure [8].
Accidents and work-related diseases
A literature review published in 2009 by the European Agency on Health and Safety at Work (EU-OSHA) concluded that quantitative data on occupational accidents and diseases is difficult to obtain. Cleaning jobs are spread across different sectors, making it difficult to implement monitoring systems. Furthermore, a significant part of cleaning work is undeclared and therefore not included in any health surveillance and OSH monitoring systems. However, the authors found data on occupational accidents from Belgium, Germany, Portugal and the UK; and on occupational diseases from Belgium [2].
Body parts most often injured are hands and fingers, feet and ankles, upper limbs and back. The most important causes of accidents are “slips and falls", “manual handling" of loads (lifting, carrying) and “moving objects". The most frequent consequences are bruises, sprains and fractures. More men suffer from occupational accidents than women. This may be explained by the gender distribution of the work; more men are employed in higher-risk cleaning activities such as industrial cleaning, refuse cleaning and window cleaning [2].
Official data from Belgium on recognised occupational diseases for the cleaning sector does not show any real trend in the disease figures between 2001 and 2006. About 90% of the victims are women, and 47% are aged 45 or older. In Belgium the most common official occupational diseases in the sector are skin diseases and tuberculosis [2].
Research studies on this topic from Belgium, Denmark, Finland, Germany, Norway, Portugal, Spain, Sweden, and UK complement this data. They indicate that MSDs - Introduction to musculoskeletal disorders- Strategies to tackle musculoskeletal disorders at work respiratory diseases and skin diseases irritants and allergens are the most common negative work-related health outcomes found in cleaners. The incidence rate of disability seems higher among cleaners than in other groups, and long-term diseases are more common in the sector. A disproportionately high number of cleaners retire early due to incapacity. Skin diseases, such as dermatitis and eczema, are frequent [2], and an elevated risk of asthma was also found. Connections have also been identified between cleaning activities and cancer (pancreas, liver, bladder, lungs, cervix, brain glioma, oesophageal squamous cell carcinoma, gastric, leukaemia, and non-Hodgkin’s lymphoma) as well as reproductive health disorders. The prevalence of mental health problems due to poor organisational conditions tends to be significant in the sector [2][7].
The situation for domestic workers is usually worse. Sometimes, issues such as salary, sick leave, working hours, vacation pay and regulation of working hours and duties cannot even be addressed because the worker is not fluent in the language, and lacks a lawyer, union, work contract or the financial where with to exit a dangerous situation. Domestic workers do not usually have workers’ compensation, are unable to report a violation, and often not in a position to quit their employment [12].
Legal aspects
At the European level, several Directives have been issued to improve OSH. Most can be classified under the Framework Directive 89/391/EEC of 12 June 1989 and its offshoots. The general Directive 'on the introduction of measures to encourage improvements in the safety and health of workers' obliges employers to take the necessary measures to ensure the safety and health of workers in all aspects of their work. The provisions of these directives are enacted through national law in each Member State.
Article 6.4 is of special interest to the cleaning sector, where workers have several workplaces, i.e. the service provider and its various clients: '… where several undertakings share a workplace, the employers shall cooperate in implementing the safety, health and occupational hygiene provisions and, taking into account the nature of the activities, shall coordinate their actions in matters of the protection and prevention of occupational risks, and shall inform one another and their respective workers and/or workers’ representatives of these risks'.
The following sub-directives are also important for the sector:
Dangerous substances: Directive 98/24/EC of 7 April 1998 on the protection of the health and safety of workers from the risks related to chemical agents at work (fourteenth individual Directive within the meaning of Article 16(1) of Directive 89/391/EEC)
Manual handling: Directive 90/269/EEC of 29 May 1990 on the minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers (fourth individual Directive within the meaning of Article 16 (1) of Directive 89/391/EEC)
PPE: Directive 89/656/EEC of 30 November 1989 on the minimum health and safety requirements for the use by workers of personal protective equipment at the workplace (third individual directive within the meaning of Article 16 (1) of Directive 89/391/EEC)
All the workplace occupational safety and health directives and related national laws in all EU Member States require employers and workers to follow general principles of prevention:
Avoiding risk
Evaluating risks which cannot be avoided
Combating risks at source
Adapting the work to the individual, especially as regards the design of the workplace, the choice of work equipment and the choice of working methods, with a view to alleviating monotonous, unduly arduous or fast-paced work
Adapting to technical progress
Replacing dangerous substances with non-dangerous or less dangerous ones
Developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the working environment
Giving collective protective measures priority over individual protective measures
Giving appropriate instructions to employees.
There are also directives on procurement that may influence the working conditions of cleaners:
2004/17/EC of the European Parliament and of the Council of 31 March 2004 coordinating the procurement procedures of entities operating in the water, energy, transport (the ‘Utilities Directive’) [13]
2004/18/EC of the European Parliament and of the Council of 31 March 2004 on the coordination of procedures for the award of public works contracts (the ‘Classical Directive’) [14]
The International Labour Organisation (ILO) Convention No. 189 offers specific protection to domestic workers. It lays down basic rights and principles, and requires states to take a series of measures with a view to making decent work a reality for domestic workers. For example, article 13 says: 'Every domestic worker has the right to a safe and healthy working environment. Each Member shall take, in accordance with national laws, regulations and practice, effective measures, with due regard for the specific characteristics of domestic work, to ensure the occupational safety and health of domestic workers.' And article 14 reads: 'Each Member shall take appropriate measures, in accordance with national laws and regulations and with due regard for the specific characteristics of domestic work, to ensure that domestic workers enjoy conditions that are not less favourable than those applicable to workers generally in respect of social security protection, including with respect to maternity.' [15]
The International Labour Organisation (ILO) conventions are legally binding international treaties that may be ratified by member states. Convention 189 will come into force on 5 September 2013. Uruguay was the first country to ratify the directive, and Italy was the first European member state to do this in January 2013 [16].
Preventive measures
The complex situation in the cleaning sector means that an holistic approach is required when it comes to implementing preventive measures. The issues to be addressed include procurement, workload, working time and schedules, work organisation, communication, qualifications, career opportunities, and work satisfaction [5].
Employers, workers, and authorities have all come up with ways to tackle these problems, independently and in combined efforts. Other valuable input has come from institutes, health and accident insurers, and consultants [4]. Developments in the field have included internet forums (e.g. UK HSE cleaners’ portal [6]), procurement guidelines, risk assessment manuals, training syllabi, as well as agreements against unfair competition and dishonest practises [4].
Several initiatives have addressed procurement, developing good practice guidelines [4].
Table 1 provides an overview of measures that can be taken at company level.
Table 1: Most common cleaning sector hazards / risks and related measures
Related to working time: cleaners mostly work outside normal office hours
Set objective targets, e.g. by using software like 'CleanNet' [17]
Make daytime cleaning possible by making some practical changes (e.g. vacuum cleaning early in the morning or using low-decibel vacuum cleaners to avoid disturbing clients). Involve all stakeholders when changing the working hours of the cleaners. Good planning and organisation is needed.
Related to work organisation: Lack of control over work and breaks, high workload and time pressure, working alone (increased risk of violence).
Introduce team-based cleaning with different levels of autonomy for the workers
This reduces time spent working alone; it increases responsibility at work to develop personal skills
The reduction of the workload and the enrichment of the job content, team-based jobs, and combi-jobs (e.g. jobs that combine caretaking and cleaning) can be introduced to cope with the negative health outcomes
Physical hazards
Ergonomic hazards:
Poor working postures (e.g. reaching and stooping)
High application of forces (e.g. scrubbing, squeezing, moving and controlling (power) equipment)
Repetitive movements (sometimes performed for up to one hour) and insufficient rest periods (all sub-sectors)
Lifting and carrying loads (especially in industrial cleaning)
Poor ergonomic design of the shape, size, adjustment and angle of handles
Poor ergonomic design of equipment in general
Consult during the procurement of cleaning tools and the design of buildings and furniture. Provide equipment and machines with adequate capacity, equipment that is adapted to the physical needs of the workers, enough workspace and essential accessories (e.g. gloves)
It is essential that purchasers take into account the particular requirements of the cleaners before equipment is purchased
The interior design of buildings should be adapted to facilitate cleaning work. Cables on floors and behind desks that force cleaners to squat and crawl to lift the cables while cleaning should be avoided
Cleaners should be properly trained to use their equipment
Employees should follow structured training on equipment use and health and safety, installation and maintenance procedures, monitoring and early warning systems for musculoskeletal health problems, e.g. introduce training concepts such as 'Moving with Awareness' [18]
Electrical equipment should be well maintained and routinely checked, repaired or replaced, and cleaners should inspect equipment for damage before use
Noise, ambient or produced by cleaning equipment (such as vacuum cleaners)
Production of quieter machines
Provision of personal hearing protection
Vibrations (caused by vibrating equipment)
Selection of tools that have minimal vibration
Equipment should be properly used and well maintained
Adequate and regular floor cleaning is essential in controlling slips, trips and falls. However, the process of cleaning can itself lead to trips, slips and falls due to wet surfaces, obstacles during cleaning, electrical cables, etc. Slip-resistant flooring surfaces and proper working shoes are essential to avoid risks. Use cable-free machines
Falls from ladders
Use extension handles instead of climbing up ladders
Use safety ladders
Thermal climate (high temperature and high relative humidity)
Cleaners should be instructed to recognise the symptoms of heat stress
Work equipment
Ergonomic design of work equipment (e.g. its weight and length)
Safe design of work equipment (e.g. no accessible sharp parts, or 'hot spots'
Employers should provide their employees with properly designed equipment, which should accommodate the physical dimensions and strength of a wide range of potential users
Employers should also provide appropriate PPE
Source: EU-OSHA [4], supplemented by author
The emerging risks (nanomaterials, EDCs) require a precautionary approach. Data and research gaps have to be considered, and measures that consider worst-case scenarios have to be applied. More research is needed. Manufacturers and suppliers of cleaning agents have to adapt their safety data sheets. Authorities and accident and health insurers must provide related guidance [8].
The cleaning sector is characterised by a large number of female workers who may either be migrants or from ethnic minorities. An EU-OSHA report shows how employers can deal with the difficulties of working in a multicultural environment, where workers have communication problems, are not fluent in the country’s official language, or speak a different language from their supervisor and colleagues. Cultural differences may need to be taken into account. The company presented in the report provides language courses for immigrants, increasing the cleaning workers’ employability. Cleaners are also offered the chance to attend cleaning courses [4].
Countries should afford more legal protection to improve the situation for domestic workers [19]. The ILO convention mentioned can be considered a first step in this direction.
Risk assessment tools
EU-OSHA began in 2009 to develop a web application (tools generator) to create interactive risk assessment tools (OiRA tools). These OiRA tools help micro and small organisations to put in place a risk assessment process – starting with the identification and evaluation of workplace risks, through decision making on preventive actions and the taking of action, to monitoring and reporting. Social partners of the cleaning sector have developed their own OiRA tool for the sector on European level. For the application on national level the tool will have to be transformed and adapted to the Member States’ conditions.
The tool allows small cleaning companies and self-employed cleaners to do their legally required risk assessment in a time effective manner and at the same time find a comprehensive inventory of up-to-date prevention and control measures, whereby they can select the most appropriate for their businesses.[20]
Outlook
By improving the health and safety of their workers, companies benefit by having healthier, confident and better qualified staff, and also improve their company image. There are also economic benefits:
Reduced health problems and absenteeism
Work is more efficient and effective due to appropriate machinery and equipment
Higher worker retention, so experience stays in the company and quality is assured
Effective work organisation is implemented
Cleaners’ motivation improved due to acknowledgement.
There has been a long tradition of social dialogue among the social partners in the European cleaning sector.[21] Their programme focuses on 5 areas: I Improvement of the knowledge of national systems II Development and promotion of vocational training III Prevention of occupational risks IV Development and recognition of the profession V Anticipation and management of change
This would seem to be a suitable approach to meet the challenges faced in the cleaning sector, and to ensure that the industry and its workers get the recognition they deserve.
References
[1] EFCI - European Federation of Cleaning Industries, ''The Cleaning Industry in Europe – An EFCI Survey'', update edition 2010, data 2008, Brussels, Belgium. Available at: http://www.feni.be
[5] FORSA - Forschungs- und Beratungsstelle Arbeitswelt, ''The Cleaning Sector: Office Cleaning, Work and Life Quality in New & Growing Jobs'', Wien, 2012. Available at: http://www.walqing.eu
[6] HSE – Health and Safety Executive (UK), Cleaning industry health and safety, (2013). Retrieved 21 January 2013, from: http://www.hse.gov.uk/cleaning/index.htm
[8] EU-OSHA – The European Agency for Safety and Health at Work, reprotox state-of-the art review, not yet published.
[9] Woodrow Wilson International Center for Scholars, Pew Charitable Trusts (2013). Consumer Products - An inventory of nanotechnology-based consumer products currently on the market. Retrieved 15 May 2013, from: http://www.nanotechproject.org/inventories/consumer/
[10] BG BAU - Berufsgenossenschaft der Bauwirtschaft (2012). GISBAU - Gefahrstoff-Informationssystem der Berufsgenossenschaft der Bauwirtschaft (German). Retrieved 3 May 2013, from: http://www.gisbau.de/index.html
[17] Clean Basic Ltd., CleanNet (software to establish working time needed for specific tasks), (2013). Retrieved 21 January 2013, from: http://www.cleanbasic.fi
[18] Huth, E., ''Moving with Awareness – An Ergonomic Approach to Training Cleaning Personnel'', undated, unpublished, see also: http://www.koerpergerechtes-arbeiten.de
EU-OSHA – The European Agency for Safety and Health at Work, Our events: Preventing harm to cleaning workers, seminar presentations and summary (2009). Retrieved 14 February 2013, from: https://osha.europa.eu/en/seminars/cleaners
Munar, S.L., Lebeer, G., Health & safety in the office cleaning sector – European manual for employees, Centre de Sociologie de la Santé of the Université Libre de Bruxelles (ULB) and the Centre de Diffusion de la Culture Sanitaire a.s.b.l., project partners uni-Europa and EFCI.
European Agency for Safety and Health at Work, Gender issues in safety and health at work – A review, Report TE5103786ENC, p. 37, 2003. Available at: http://osha.europa.eu/publications/reports/209
HSE – Health And Safety Executive, Caring for cleaners. Guidance and case studies on how to prevent musculoskeletal disorders, HSG234. Available at: http://www.hse.gov.uk/press/2003/e03078.htm
HSE – Health And Safety Executive, Slips and trips in the healthcare services, Health services sheet No. 2, 2003. Available at: http://www.hse.gov.uk/pubns/hsis2.pdf
HSE – Health And Safety Executive, Slips and trips: The importance of floor cleaning, HSE information sheet slips and trips 2, 2005. Available at: http://www.hse.gov.uk/pubns/web/slips02.pdf
Huth, E., ‘Arbeitsfelder: Arbeits- und Gesundheitsschutz in der Reinigung, Reinigungs- und Hygiene – Technik’, Facility Management. Available at: http://www.bewegungs-abc.de/haupt.htm.
Huth, E., Krueger, D., Kopf, T., Gestaltung Gesunder Artbeitsbedingungen: Projekt Reinigung, Gesundheitsförderung für die Mitarbeiterinnen des Referates Technik und Hausverwaltung im Hygiene Institut Hamburg, Fachhochschule Hamburg, 2001
Huth, E., Krueger, D., Zorzi, G., Gesundheitsförderung im Krankenhausbetrieb – Funktionsbereich Reinigung, Abschlußbericht, Fachhochschule Hamburg, 1996
Vogel, Laurent, ‘The TUTB study on gender sensitivity in occupational safety and health: some results and their implications’, European Agency for Safety and Health at Work: Mainstreaming gender into occupational safety and health, Proceedings of a seminar organised in Brussels on 15 June 2004. Available at: http://osha.europa.eu/publications/reports/6805688
Zock, J.P., Kogevinas, M., Sunyer, J., Almar, E., Muniozguren, N., Payo, F., Sánchez, J.L., Antó, J.M.; ‘Asthma risk, cleaning activities and use of specific cleaning products among Spanish indoor cleaners’, Scand J Work Environ Health. 27(1), Feb 2001, pp.76-81.
