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PITTSBURGH -- The Association of Association of Occupational Health Professionals in Healthcare (AOHP) recently surveyed its members to determine top public policy issues of concern to its members. Based on these findings, AOHP released a statement regarding its 2007-2009 public policy slate.
In an effort to respond to member needs, the AOHP conducted a member survey in August 2006; the survey results identified the following topics as the top public policy issues of concern to AOHP members over the next two years:
Bloodborne Pathogen Exposure
AOHP advocates for a policy in which individual states remove the current statutory requirement for special written consent for HIV testing so as to expedite exposure source testing in the case of a blood or body fluid exposure involving a healthcare worker. The Association also continues to advocate for policy that supports a safer environment for employees via the use of safer technology, education, training and prevention regarding sharps injuries. AOHP will be working on this issue in conjunction with two key partners, OSHA and NIOSH.
Fifty-seven healthcare personnel in the United States have been documented as having seroconverted to HIV following occupational exposures. Twenty-six have developed AIDS. There are another 140 with possible, unconfirmed seroconversion.
Critical to the evaluation and management of a healthcare worker who has sustained a blood or body fluid exposure is the timely testing of the source patient for HIV.Â This serves to shorten the time that HIV anti-viral prophylaxis is needed, eliminates the need for follow-up testing, and reduces the level of worker anxiety over the exposure.
Many states currently require special written consent with counseling prior to the ordering of HIV tests on any individual in the healthcare system. The Centers for Disease Control and Prevention (CDC) recently revised its recommendation for HIV testing of adults, adolescents, and pregnant women in healthcare settings (Recommendation and Reports, September 22, 2006/55 RR14).
The CDC advocates that HIV screening should be incorporated into the general consent for medical care after the patient is notified that testing will be performed unless the patient declines or opts out.Â Separate written consent is no longer recommended.Â The CDC has further recommended that prevention counseling should not be required with HIV diagnostic testing, or as part of HIV screening programs in healthcare settings.
Safe Patient Handling
AOHP supports efforts to ensure a safer healthcare environment for both the patient and the employee, including utilizing lift/assist devices as the primary method for the prevention of back injuries. For patient transfers, lifts, and repositioning, mechanical equipment must be provided by the facility and used by the caregivers. The Association advocates for regulations, legislation, education, training, research, and prevention activities as related to safer patient handling activities and methodologies. The AOHP/OSHA Alliance has produced a resource guide on this issue and plans to also work on revising the e-tool to incorporate additional patient handling information for acute care settings. AOHP will work to influence both state and national legislation as it relates to Safe Patient Handling. Texas and Washington are two states that have passed such legislation in the last one to two years.
Back injuries and other musculoskeletal disorders related to patient handling are the leading cause of workplace disability for nurses and other direct patient care providers. Each year approximately 40,000 nurses report illnesses from back pain. This represents over three-quarters of a million lost workdays annually due to back injuries among nurses. Many of these injuries are related to manual patient transfer and repositioning tasks. Back injuries may not be the most frequent injury, but they do result in the most lost workdays.
AOHP supports efforts to ensure a safer workplace for employees by utilizing systems and processes that are evidence-based and supported through research. The association advocates for increased research, training and education as related to respiratory protection from tuberculosis (TB) and other airborne respiratory transmissible diseases. With AOHP and NIOSHs Memorandum of Understanding, work will be done to provide input into recommendations in this area.
Tuberculosis continues to be an ongoing infectious disease issue in the healthcare setting. Diagnosis of the disease is most important in preventing its spread along with regular screening of healthcare workers. On Dec. 31, 2003, the Occupational Safety and Health Administration (OSHA), discontinued activity on a regulation focused on tuberculosis. Instead, a ruling was made to include the particulate respirator -- that is recommended for personal protection against TB -- be removed and included with the Federal Register for General Industry Respiratory Protection standard. This regulation requires annual fit testing and education for all respirator wearers.
There has been ongoing legislation and research in this area since that time. For the last several years, federal appropriations have been withheld from OSHA to enforce the standard. Several states (California and Washington) are state-funded states that have chosen to enforce the regulation in requiring annual fit testing and training.