When behavior outweighs infrastructure: disinfectant and latex exposure and preventive practice among operating room nurses in China

Background Operating-room (OR) nurses encounter disinfectants, sterilizing agents, and latex products as embedded job tasks, yet their multi-domain symptom burden, safety awareness, and preventive practices have rarely been examined together, particularly in Chinese tertiary-care settings. Methods We undertook a single-center cross-sectional investigation of operating-room nurses at a tertiary hospital in China. A rigorously structured questionnaire captured agent-specific exposure frequency, task-based exposure, occupational symptomatology, safety awareness, and preventive practices. Composite exposure, awareness, and practice indices were systematically derived. Associations linking exposures, workplace controls, and five binary symptom outcomes were quantified through modified Poisson regression with robust variance estimation, expressed as adjusted prevalence ratios (aPRs). Results Among 1,271 OR nurses (87.7% women; mean age 32.9 years), regular (weekly or more) exposure was highest for alcohol-based antiseptics (54.1%), latex products (42.7%), quaternary ammonium compounds (38.6%), and chlorine (32.5%), while high-level sterilants ranked lowest. Work-related mucosal/ocular symptoms were most prevalent (33.2%), followed by skin (22.3%), healthcare or work impact (10.1%), respiratory (8.7%), and latex-compatible symptoms (6.3%). Current smoking (aPR 2.00) and multiple-agent co-exposure (aPR 1.99) were independently associated with a higher prevalence of respiratory symptoms, whereas higher preventive-practice scores were associated with approximately half the prevalence (aPR 0.50). Adequate ventilation was associated with a lower prevalence of mucosal/ocular symptoms (aPR 0.82), and latex exposure was associated with skin symptoms (aPR 1.05 per 10 points). Overall, 644 of 1,271 nurses (50.7%) met the a priori threshold for adequate safety awareness (score ≥6/8). Safety infrastructure predicted stronger preventive practice but not lower symptom burden. Conclusion Chemical symptom burden among OR nurses was substantial, multi-domain, and behaviorally modifiable. Prevention should combine behavior-specific training, targeted substitution, and ventilation controls with organizational measures addressing workload, supported by active symptom surveillance.