Blood exposure incidence rates from the North Carolina study of home care and hospice nurses

Determinants associated with the incidence of occupational accidents among visiting nurses from home-visit nursing agencies: Secondary analysis of cross-national survey data in Japan

AIM

This study aimed to determine the incidence of occupational accidents among home-visiting nurses from home-visit nursing agencies and relevant factors.

METHODS

Data from a questionnaire survey, conducted in March 2020, concerning home-visit nursing agencies were used as a secondary source. A total of 9979 agencies were surveyed. The questionnaires included items relating to the number of occupational accidents experienced by visiting nurses that occurred during a 3-month period. The occurrence of accidents in an agency was set as a dependent variable, and logistic regression analysis was performed on its association with agency attributes. For agencies in which accidents occurred, the number of accidents per 10 full-time-equivalent nurses was estimated, and multiple regression analysis was administered to investigate its association with agency attributes.

RESULTS

The findings of the logistic regression analysis revealed that new agencies, a greater number of full-time-equivalent nurses, emergency visitation support, and performing an analysis of accident cases for accident prevention were significantly associated with the occurrence of accidents. A median of 3.3 accidents occurred per 10 full-time-equivalent nurses at such agencies. Multiple regression analysis showed that a lower number of full-time-equivalent nurses was significantly associated with an increase in the frequency of accidents.

CONCLUSIONS

These results suggest that to devise and deploy safety measures for visiting nurses, all home-visit nursing agencies must build reporting and analysis systems for occupational accidents among home-visiting nurses. Moreover, ensuring safety measures for nurses working in small-scale agencies is of utmost importance. Geriatr Gerontol Int 2022; ••: ••-••.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

Risk of Sharps Injuries to Home Care Nurses and Aides: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate all available literature and develop a pooled estimate of the risk of sharps injuries (SI) among home care (HC) nurses and aides.

METHODS

A systematic literature search was conducted and relevant articles were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome data from studies identified by the systematic review were pooled using a random effects model to calculate a summary measure of SI risk for nurses and for aides.

RESULTS

Five articles were included in the final analysis. Nurses had a 5.25% weighted average risk of experiencing at least one SI in the past year while working in HC (95% confidence interval [CI]: 3.11% to 7.40%); aides pooled SI risk was 1.74% (95% CI: 0.72% to 2.77%).

CONCLUSIONS

Combining findings of all available studies demonstrates that there is a serious risk of SI among both the HC nurses and aides.

Safety Risks Among Home Infusion Nurses and Other Home Health Care Providers

In the United States, home health care (HHC) is a rapidly growing industry and home infusion therapy is a rapidly growing market. HHC can present substantial occupational safety and health (OSH) risks. This article summarizes major OSH risks relevant to home infusion therapy by illustrating them through real-life scenarios collected systematically using qualitative research methods by the National Institute for Occupational Safety and Health-funded research projects at the University of Massachusetts Lowell. The need for home infusion therapy will continue to grow in the future, and safety interventions to prevent or minimize OSH risks are essential.

Determinants of occupational injury for US home health aides reporting one or more work-related injuries

OBJECTIVES

Home health aides (HHAs) work in a high-risk industry and experience high rates of work-related injury that have been significantly associated with reduction in workers and organisational productivity, quality and performance. The main objective of the study was to examine how worker environment and ergonomic factors affect HHA risk for reporting occupational injuries.

METHOD

We used cross-sectional analysis of data from the 2007 National Home Health and Hospice Aide Survey (NHHAS). The study sample consisted of a nationally represented sample of home health aides (n=3.377) with a 76.6% response rate. We used two scales ¹ : a Work Environment Scale and ² an Ergonomic Scale. Univariate and bivariate analyses were conducted to describe HHA work-related injury across individual, job and organisational factors. To measure scale reliability, Cronbach's alphas were calculated. Multivariable logistic regression was used to determine predictors of reported occupational injury.

RESULTS

In terms of Work Environment Scale, the injury risk was decreased in HHAs who did not consistently care for the same patients (OR=0.96, 95% CI: 0.53 to 1.73). In terms of Ergonomic Scale, the injury risk was decreased only in HHAs who reported not needing any other devices for job safety (OR=0.30, 95% (CI): 0.15 to 0.61). No other Work Environment or Ergonomic Scale factors were associated with HHAs' risk of injury.

CONCLUSION

This study has great implications on a subcategory of the workforce that has a limited amount of published work and studies, as of today, as well as an anticipated large demand for them.

Risk of sharps injuries among home care aides: Results of the Safe Home Care survey

OBJECTIVES

Home care (HC) aides constitute an essential, rapidly growing workforce. Technology advances are enabling complex medical care at home, including procedures requiring the percutaneous use of sharp medical devices, also known as sharps. Objectives were to quantify risks of sharps injuries (SI) in a large HC aide population, compare risks between major occupational groups, and evaluate SI risk factors.

METHODS

A questionnaire survey was administered to aides hired by HC agencies and directly by clients. One thousand one hundred seventy-eight aides completed questions about SI and potential risk factors occurring in the 12 months before the survey. SI rates were calculated and Poisson regression models identified risk factors.

RESULTS

Aides had a 2% annual risk of experiencing at least 1 SI (95% confidence interval [CI], 1.1-2.6). Client-hired aides, men, and immigrants had a higher risk than their counterparts. Risk factors among all HC aides included helping a client use a sharp device (rate ratio [RR], 5.62; 95% CI, 2.75-11.50), observing used sharps lying around the home (RR, 2.68; 95% CI, 1.27-5.67), and caring for physically aggressive clients (RR, 2.82; 95% CI, 1.36-5.85).

CONCLUSIONS

HC aides experience serious risks of SI. Preventive interventions are needed, including safety training for clients and their families, as well as aides.

Safety climate and use of personal protective equipment and safety medical devices among home care and hospice nurses

Use of personal protective equipment (PPE) and safety medical devices is mandated for healthcare workers to reduce the risk of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) from exposure to patients' blood. Research has shown that a strong safety climate may promote increased use of PPE. Therefore, the objective of this study was to examine the association between safety climate and use of PPE among homecare/hospice nurses in North Carolina. To this end, a mail survey was conducted in 2006. The response rate, adjusted on the assumption that the proportion of eligible nurses from among those who did not return the questionnaire or could not be contacted was similar to the proportion among those who did return the questionnaire, was 69% (n=833 eligibles). The percentage of nurses who used the specified PPE was two to three times greater among nurses who had a strong safety climate. Safety climate was only weakly associated with using safety devices. These results suggest that improving safety climate may be a powerful tool for increasing use of PPE.

Characterizing the nature of home care work and occupational hazards: a developmental intervention study

BACKGROUND

Home care (HC) aide is the fastest growing occupation, yet job hazards are under-studied. This study documents the context of HC aide work, characterizes occupational safety and health (OSH) hazards, and identifies preventive interventions using qualitative methods.

METHODS

We conducted 12 focus groups among aides and 26 in-depth interviews comprising 15 HC agency, union, and insurance company representatives as well as 11 HC recipients in Massachusetts. All focus groups and interviews were audio-recorded, transcribed, and coded with NVIVO software.

RESULTS

Major OSH concerns were musculoskeletal disorders from client care tasks and verbal abuse. Performing tasks beyond specified job duties may be an OSH risk factor. HC aides' safety and clients' safety are closely linked. Client handling devices, client evaluation, care plan development, and training are key interventions for both aides' and clients' safety.

CONCLUSIONS

Promoting OSH in HC is essential for maintaining a viable workforce.

Work experience, work environment, and blood exposure among home care and hospice nurses

Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.

Using formative research to design an epidemiologic survey: the north Carolina study of home care and hospice nurses

OBJECTIVES

Formative research can serve as a means of obtaining important information for designing an epidemiologic study, but descriptions of this approach in the epidemiologic literature are lacking. The objective of this paper is to describe the use of three formative research techniques in designing a survey of home care and hospice nurses.

METHODS

We conducted two focus groups, seven key informant interviews, and approximately fifteen hours of direct observation among home care and hospice nurses recruited by word of mouth in North Carolina in 2006.

RESULTS

We used information obtained from the formative research to decide which survey design would likely be most successful with this population (mail survey, as opposed to Internet survey or in-person interviews), which measure to use for the denominator of the blood exposure incidence rates (number of visits, as opposed to patient-time), and which items and response options to include in the questionnaire, as well as to identify specific survey techniques that would likely increase the response rate (emphasizing the regional focus of the study; sending the questionnaire to the home address).

CONCLUSION

When particular information for planning a study is unavailable from the literature or the investigator's experience, formative research can be an effective means of obtaining that information.

Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

Le but de cette conception qualitative et interprétative était d’examiner les perspectives des chercheurs, des pourvoyeurs de soins de santé et et des décideurs aux sujets des risques principaux, des préoccupations et des problèmes émergents rattachées à la sécurité de soins à domicile qui informerait une ligne d’enquête de recherche. La sécurité, tel qu’elle s’applique spécifiquement à ce context des soins à domicile, n’a pas encore été définie. Par conséquent, afin de profiter de diverses parties prenantes sur les questions de securité relatives aux soins à domicile est nécessaire afin d’informer les orientations stratégiques pour la recherche future. Afin de commencer à tracer un programme de recherche, une analyse en trois parties de l’environnement a été realisée: (a) une étude pilote avec les bénéficiaires et les fournisseurs de soins à domicile; (b) des entretiens avec des informateurs clés, les chercheurs, les fournisseurs de soins de santé, et les décideurs; et (c) une revue de la littérature dans trois domaines thématiques. Seulement les résultats des entrevues des informateurs clés sont présentés ici.

Provision and use of personal protective equipment among home care and hospice nurses in North Carolina

BACKGROUND

We investigated the frequency with which home care/hospice nurses are provided with and use personal protective equipment (PPE) and factors associated with use.

METHODS

We conducted a mail survey among home care/hospice nurses in North Carolina in 2006.

RESULTS

The adjusted response rate was 69% (n = 833). Between 68% and 86% of nurses were always provided with the relevant types of PPE; these nurses were 2.5-3 times more likely to use the PPE in scenarios involving a potential for blood exposure compared with nurses who were not always provided with PPE. Nurses who always had sufficient time during home visits were 50% more likely to use PPE. Nurses who visited more homes with adverse working conditions were less likely to use PPE.

CONCLUSION

The public health policy of providing PPE to health care workers and ensuring that they use that equipment to prevent occupational blood exposure is not being fully implemented for home care and hospice nurses. Greater provision of PPE could reduce blood exposure in this population. Conditions of the home care/hospice work environment may be impeding nurses' ability to use PPE.

Provision and use of safety-engineered medical devices among home care and hospice nurses in North Carolina

BACKGROUND

Nurses who provide care in the home are at risk of blood exposure from needlesticks. Using safety-engineered medical devices reduces the risk of needlestick. The objectives of this study were to assess provision of safety devices by home care and hospice agencies as well as the use of these devices by home care and hospice nurses in North Carolina, and to examine the association between provision and use.

METHODS

A mail survey was conducted among North Carolina home care and hospice nurses in 2006.

RESULTS

The adjusted response rate was 69% (n = 833). The percentage of nurses who were always provided with safety devices ranged from 51% (blood tube holders) to 83% (winged steel needles). Ninety-five percent of nurses who were always provided with safety devices, but only 15%-50% of nurses who were not always provided with safety devices, used a safety device the last time they used that general type of device. Among nurses who did not use a safety device on that occasion, 60%-80% did not use it because it was not provided by the agency.

CONCLUSION

This study suggests that limited access is the primary reason for home care/hospice nurses' failure to use safety devices. The policy goal of providing safety devices to health care workers in all situations in which such devices could reduce their risk of needlestick is not being achieved for home care nurses in North Carolina.