A Risky Business

September 27, 2007

As the second-fastest growing sector of the United States economy, the healthcare industry employs more than 12 million workers dedicated to protecting the health of their patients. But who is responsible for protecting the health and safety of these healthcare workers?

The Danger Zone

Over the past decade, the rates of occupational injury to healthcare workers (HCWs) have continued to rise. From occupational hazards like communicable diseases, sharps injuries, infectious- fluid splashes, latex allergies, back injuries, violence and stress, healthcare staff members are at risk.

In order to prevent or reduce exposure to these day-to-day dangers, infection control professionals must interface with healthcare personnel to identify risks, increase awareness of safety challenges, implement protective policies and procedures, and evaluate measures after they are taken. In addition, groups like the Association of Occupational Health Professionals in Healthcare (AOHP), the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) also are in place to promote and advance the health and safety of workers in healthcare.

But in order for infection control personnel and occupational health advocacy groups to develop better policies and practices that prevent work-related injuries, they must first understand what todays healthcare workers are facing by looking at what ranks among the top safety concerns.

To achieve this goal, AOHP designed a survey to illuminate the top public policy issues of concern to its members. The survey, conducted in August 2006, examined the most common safety challenges faced by occupational HCWsincluding bloodborne pathogen exposure, violence in the workplace, safe patient handling, ergonomics, bioterrorism/emergency preparedness, health promotion/wellness, respiratory protection and pandemic influenzaand asked approximately 340 respondents to rank the issues as very important, important, somewhat important or unimportant.

The results revealed that the top three pressing concerns for todays healthcare workers are safe patient handling, blooborne pathogen exposure and respiratory protection. Safe patient handling and bloodborne pathogen exposure were both ranked as very important by 76.7 percent and 73.5 percent of voters, respectively, while respiratory protection was considered important by 52.1 percent of respondents.

Watch Your Back

According to the Federal Bureau of Labor Statistics, six of the top 10 occupations at the highest risk for back injuries are in healthcarewhich makes it easy to understand why safe patient handling ranked as the No. 1 issue of concern for surveyed AOHP members.

Musculoskeletal injuries are the most common injuries incurred by occupational health staff, particularly in regard to the neck, shoulders, back and arms, says Sandra Domeracki-Prickitt, RN, FNP, COHN-S, executive vice president of the AOHP. In fact, HCWs have a higher incidence of these types of injuries than construction workers, mostly stemming from patient handling.

In a healthcare environment, patients need to be positioned, assisted in and out of beds and chairs, and transferred from cart to bed multiple times each day. Unfortunately, recommended lifting techniques do not always work in regard to repositioning or transferring a person. The traditional lift from the knees approach may not be effective for a variety of reasonssuch as workers being thrown off-balance by patient movement, not being able to work around equipment and furniture, or simply not having the strength to lift from the legswhich forces HCWs to place undue stress on their muscles, ligaments and joints, subjecting them to a higher probability of injury.

As a result, it is recommended that HCWs use equipment like mechanical lifting devices to do the heavy work of lifting and pulling. This ergonomic approach to safe patient handling and transfer is often called a no-lift or zero-lift policy, and means that healthcare workers do not lift, shift or transfer patients without the use of an assistive device. The result is a safer environment for the patient and for the worker.

Using equipment decreases the risk of injury and can lessen the impact of any injury that does occur, Domeracki-Prickitt says.

Additionally, with the approximately 40,000 nurses reporting illnesses from back pain each year, there are more than three-quarters of a million lost workdays. Therefore, decreasing the amount of injuries incurred by healthcare staff can reduce Workers Compensation claims, days lost due to injury and the permanent loss of a worker because of a severe injury.

Patient handling-related injuries are particularly hazardous because there is always the possibility of permanent disability, she says. These types of injuries must be avoided if we want to preserve our nursing and healthcare pool of workers.

Healthcare Cooties

Coming in a close second to safe patient handling is concern regarding occupational exposure either through direct or indirect contactto blood or other potentially infectious materials. Such exposure places workers at risk of infection from bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and more.

Occupational health professionals are largely concerned with bloodborne pathogen exposure, Domeracki-Prickitt says. The goal is to completely eradicate blood or body fluid exposures, but it is still a challenge in the healthcare workplace.

Direct contact transmission involves skin-to-skin contact and physical transfer of microorganisms and is most often the result of accidents relating to handling sharp devices, scalpels, sutures, hypodermic needles, and blood-collection equipment, or fluid splashes near the eyes, nose, mouth or broken skin. Indirect contact transmission spreads infection from one person to another following contact with a contaminated object.

In order to protect the patient and the HCW from these exposures, OSHAs Bloodborne Pathogens Standard should be followed, along with the implementation of contact precautions and use of personal protective equipment. These tools are designed to reduce the risk of transmission of epidemiologically-important microorganisms and must be followed consistently by all HCWs. Engineering controls (which are designed to isolate or remove the bloodborne pathogens hazard from the workplace through tools like sharps disposal containers, self-sheathing needles, or needleless systems) and work-practice controls (which change how a HCW performs a task so as to limit the potential for exposure) also are effective methods of exposure prevention.

Unfortunately, violations occur and most often those violations are the decision of the workers who know the precautions are in place for their protection and that of their patients. But if bloodborne pathogen exposure is one of the biggest concerns of HCWs, why would they avoid following safety measures?

Domeracki-Prickitt says that time issues are one of the most common causes of noncompliance.

In any kind of accident of injury situation, workers are in a hurry due to the critical nature of the patient, she adds. Workers that are in hurry may neglect safety steps like not wearing the proper protective gear as a result.

Additionally, a lack of training regarding the use of safety devices coupled with a reluctance to break out of old habits is a widespread cause of violations.

While the newer pool of workers joining the workforce are already trained to use the safety devices, older workers may not be and sometimes can be reticent to use these new tools, Domeracki-Prickitt says. Also, there are still those workers who will deactivate safety features simply because they are not comfortable working with the tool while the safety is on.

In addition, Domeracki-Prickitt acknowledges the need for improvement in the design of the safety devices.

A largely problematic area regarding violations occurs within surgical and operating areas, she says. There are scalpels and needles that are blunted, but these devices cannot always be used in every circumstance. Basically, safety devices are improving but there is still no perfect tool for everything that an occupational worker needs to do.

In order to ensure that the safety device is used consistently and common reasons for noncompliance are avoided, OSHA recommends that safety devices should be easy-to-use, practical, needleless, work effectively without adversely affecting patient care, and feature a safety aspect that is an integral part of the device which cannot be deactivated and remains protective through disposal.

Ultimately, IC staff must be vigilant in observing compliance and stepping in when rules are not being followed. If HCWs understand why these contact precautions are in place and are properly trained on how to implement them, the chances of the HCW choosing to disregard them will decrease.

Breathe Easy

Coming in as the third concern of HCWs is protection from airborne respiratory transmissible diseases. The contraction of infectious organisms continues to be an ongoing issue in the healthcare setting, in regard to diseases like tuberculosis (TB), influenza, and severe acute respiratory syndrome (SARS). Increased attention must be given to the prevention of airborne diseases to set workers minds at ease.

As with all aspects of occupational health safety, the key to controlling respiratory hazards is to follow correct work practices and prescribed engineering controls. One effort to prevent the transmission of airborne respiratory transmissible diseases can be seen in the use of respirators, which provide a barrier to prevent HCWs from inhaling bacteria.

The level of protection a respirator provides is determined by the efficiency of the filter material and how tightly it seals to the workers face. Because of this, masks/respirators must be approved by NIOSH, and personnel should be fittested for different facial sizes and characteristics. Additionally, HCWs are instructed to perform a fit check, in accordance with OSHA standards, each time the mask/respirator is worn.

Domeracki-Prickitt says the most prevalent airborne respiratory transmissible disease of concern to HCWs is tuberculosis (TB). More than one-third of the worlds population now carries the TB bacterium and new infections occur at a rate of one per second.

There is a concentrated effort to limit the level of active tuberculosis in the United States, she adds. There are other airborne respiratory screening policies, but TB is the primary focus.

Overall, minimizing the risk for transmission of tuberculosis is of utmost importance. To do this, strict controls must be followed and periodically reviewed and evaluated for effectiveness.

It is recommended by the Centers for Disease Control and Prevention (CDC) that HCWs receive regular screenings for tuberculosis, Domeracki-Prickitt says. In addition, most states have specific laws and regulations to govern the infectious disease.

Airborne transmission of pathogens is an area of increasing concern to HCWs, and the AOHP, OHSA and NIOSH are strongly advocating for more research, training and education as related to respiratory protection from tuberculosis and other respiratory transmissible diseases. In particular, the AOHP and NIOSH are striving to provide input for recommendations in regard to this health safety issue.

Safety First

The occupational hazards faced by todays healthcare workers are numerous and IC personnel, the AOHP, OSHA and NIOSH are at the forefront of the struggle to provide a safe environment for patients and staff.

These collaborative relationships are intended to improve workplace safety and health in the healthcare setting through the development and dissemination of information surrounding key subjects, Domeracki-Prickitt says. Also, to further the push toward proper training, the AOHP has done a lot of work updating the e-tools section of the OSHA Web sitewhich has a variety of interactive training on occupational safety and health topicsin regard to employee issues in a hospital or healthcare setting. We are really trying to develop a quick reference resource for occupational health safety measures.

Together, these groups are dedicated to advancing occupational safety through regulations, legislation, research, education and trainingparticularly in reference to the issues that are of top concern to todays HCWs.

Through methods like the AOHP survey, these groups are able to gather information regarding what healthcare workers are facing on a daily basis, and then translate that into policies and procedures that will change the face of the healthcare industry and occupational healthcare worker safety.

Ultimately, IC personnel and safety advocacy organizations are taking it upon themselves to be responsible for protecting and promoting the health of the workers who protect and promote the health of the public.