Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection

Perception of occupational health and safety in the manufacturing sector: a qualitative evaluation

Objectives. Earlier work found gaps with respect to legislative compliance and disparities in perceptions, attitudes and beliefs towards occupational health and safety in the Ontario manufacturing sector. The current follow-up study was undertaken to gain a more thorough understanding of the cause of these gaps and differences in perspectives. Methods. Focus group discussions were held with workers and managers separately. Key questions related to health and safety in general, health and safety training, and health and safety communication were asked of each focus group. The discussions were qualitatively analysed. Results. Overall, 12 worker focus groups (n = 76) and seven manager focus groups (n = 38) were conducted. Individuals who felt safe in their workplace indicated that it was a supportive environment, and that health and safety was a priority. Health and safety training was considered important but improvements in engagement and frequency were suggested. Conclusions. Health and safety communication might be hindered by technical terms and language barriers. Delivering this communication in multiple ways as well as the tone of communication should be taken into consideration. Overall, safety culture was lacking and manufacturing workplaces should be mindful of the gaps identified to improve health and safety performance.

Knowledge, Attitudes, and Practices Related to Mold Remediation Following Hurricane Ida in Southeast Louisiana

Hurricane Ida, a Category 4 hurricane, made landfall in southern Louisiana in August of 2021, causing widespread wind damage and flooding. The objective of this study was to investigate knowledge, attitudes, and practices related to post-hurricane mold exposure and cleanup among residents and workers in areas of Louisiana affected by Hurricane Ida and assess changes in knowledge, attitudes, and practices that have occurred over the past 16 years since Hurricane Katrina. We conducted in-person interviews with 238 residents and 68 mold-remediation workers in areas in and around New Orleans to ask about their mold cleanup knowledge and practices, personal protective equipment use, and risk perceptions related to mold. Knowledge of recommended safety measures increased since the post-Katrina survey but adherence to recommended safety measures did not. Many residents and some workers reported using insufficient personal protective equipment when cleaning up mold despite awareness of the potential negative health effects of mold exposure.

Assessing a safety climate tool adapted to address respiratory illnesses in Canadian hospitals

Background

Studies have shown an association between workplace safety climate scores and patient outcomes. This study aimed to investigate (1) performance of the hospital safety climate scale that was adapted to assess acute respiratory illness safety climate, (2) factors associated with safety climate scores, and (3) whether the safety scores were associated with following recommended droplet and contact precautions.

Methods

A survey of Canadian healthcare personnel participating in a cohort study of influenza during the 2010/2011-2013/2014 winter seasons. Factor analysis and structural equation modeling were used for analyses.

Results

Of the 1359 participants eligible for inclusion, 88% were female and 52% were nurses. The adapted items loaded to the same factors as the original scale. Personnel working on higher risk wards, nurses, and younger staff rated their hospital's safety climate lower than other staff. Following guidelines for droplet and contact precautions was positively associated with ratings of management support and absence of job hindrances.

Conclusion

The adapted tool can be used to assess hospital safety climates regarding respiratory pathogens. Management support and the absence of job hindrances are associated with hospital staff's propensity and ability to follow precautions against the transmission of respiratory illnesses.

Examining the Roles of Training, Fit Testing, and Safety Climate on User Confidence in Respiratory Protection: A Case Example with Reusable Respirators in Health Delivery Settings

A lack of confidence in the efficacy of respiratory protection can contribute to uncertainty among workers and cast doubt on workplace safety. To date, no research has been conducted to study and understand the introduction of elastomeric half-mask respirators (EHMRs)-without exhalation valves (EVs) or with exhalation valve filters (EVFs), both representing new designs that address source control-in the workplace. To study this issue, researchers collaborated with partners at 32 health delivery settings that received EHMRs from the Strategic National Stockpile during the COVID-19 pandemic. EHMR users (n = 882) completed an online survey between October 2021 and September 2022. Analyses demonstrated that employees were statistically significantly more confident in the efficacy of EHMRs with no EV/with an EVF (including the efficacy in protecting the user from COVID-19) if they had been fit tested and received training. Respondents were also statistically significantly more confident in the efficacy of their EHMR if they had a more positive perception of their organization's safety climate. The results provide insights for tailored fit testing and training procedures as manufacturers continue to improve respirator models to enhance worker comfort and use. Results also show that, even during a public health emergency, the role of safety climate cannot be ignored as an organizational factor to support worker knowledge, attitudes, and participation in health and safety behaviors specific to respirator use.

A pilot study of changes in Total Worker Health® policies and programs and associated changes in safety and health climates in small business

BACKGROUND

There is little longitudinal research on whether changes to Total Worker Health® (TWH) policies and programs are associated with changes in health climate and safety climate. We hypothesize that as TWH policies and programs change, employees will report changes in safety climate and health climate from baseline to 1 year.

METHODS

Twenty-five diverse small businesses and their employees participated in assessments completed approximately 1 year apart. The exposures of interest, TWH policies and programs, were measured using the business-level Healthy Workplace Assessment™ which collects information on six benchmarks. The outcomes of interest, employee perceptions of safety climate and health climate, were measured via an employee survey. We employed paired t-tests and simple linear regression to assess change over a 1-year period.

RESULTS

The mean Healthy Workplace Assessment overall score changed by 11.3 points (SD = 11.8) from baseline to Year 1. From baseline to Year 1, the mean scores of each benchmark changed in a positive direction within this sample. The mean safety climate score and health climate score changed by +0.1 points (SD = 0.2) and +0.1 points (SD = 6.4) from baseline to Year 1, respectively. The associations between changes in the overall Healthy Workplace Assessment score and health climate and safety climate scores were negligible [β = 0.01 (95% confidence interval [CI]: 0.002, 0.02), and β = 0.01 (95% CI: 0.002, 0.02), respectively].

CONCLUSION

Our study suggests that when small businesses improve upon their TWH policies and programs they experience marginal measurable improvements in employee perceptions of their workplace safety climate and health climate.

Prevalence of Percutaneous Injuries and Associated Factors Among a Sample of Midwives in Hunan Province, China

Background: Percutaneous injuries and blood-borne-related infections pose occupational hazards to healthcare professionals. However, the prevalence and associated factors for these hazards among midwives in Hunan Province, China are poorly documented. Methods: A cross-sectional study was conducted among a sample of 1,282 eligible midwives in the cities of Yongzhou, Chenzhou, Hengyang, and Changsha in Hunan Province, China, from January 2017 to July 2017. The association of selected independent variables with percutaneous injuries was investigated using binary logistic regression. Results: 992 participants responded (77.3%), and within the previous 12 months, 15.7% experienced percutaneous injuries. In multivariate analysis, hospital size, age, length of employment as a midwife, weekly working hours, and three aspects of Hospital Safety Climate Scale were associated with percutaneous injuries. The risk of percutaneous injuries among the midwives working in hospitals with ≤399 beds was higher than that among those working in hospitals with ≥400 beds by nearly 3 times. Furthermore, the percutaneous injury prevalence of midwives decreased as age increased. Moreover, the probability of percutaneous injuries among the midwives with weekly working hours of >40 was 4.35 times higher compared with that among midwives with weekly working hours of ≤40. Conclusion/Application to practice: The prevalence of percutaneous injuries among midwives in the study hospitals was substantial. Our results further proved that risk mitigation strategies tailored to midwives are needed to reduce this risk. These strategies include ensuring a positive organizational climate, providing highly safe devices, and reducing the workload.

Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk

PURPOSE

We investigated the impact of elements of a workplace culture of health (COH) on employees' perceptions of employer support for health and lifestyle risk.

DESIGN

We used 2013 and 2015 survey data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initiative to help workplaces implement health-promoting interventions.

SETTING

Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes.

PARTICIPANTS

Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes.

MEASURES

We defined elements of a COH as environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees' perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use.

ANALYSIS

We estimated effects using multilevel regression models.

RESULTS

At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health ( P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports ( P < .10) and significant associations with leadership support in 2015 only ( P < .05).

CONCLUSION

Relational elements of COH (leadership and coworker support) tend to be associated with perceived support for health, while workplace elements (environmental and policy supports) are more associated with lifestyle risk. Employers need to confront relational and workplace elements together to build a COH.

Exploring respiratory protection practices for prominent hazards in healthcare settings

The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.

Assessment of influenza virus exposure and recovery from contaminated surgical masks and N95 respirators

Healthcare workers (HCWs) are at significantly higher risk of exposure to influenza virus during seasonal epidemics and global pandemics. During the 2009 influenza pandemic, some healthcare organizations recommended that HCWs wear respiratory protection such as filtering facepiece respirators, while others indicated that facemasks such as surgical masks (SMs) were sufficient. To assess the level of exposure a HCW may possibly encounter, the aim of this study was to (1.) evaluate if SMs and N95 respirators can serve as "personal bioaerosol samplers" for influenza virus and (2.) determine if SMs and N95 respirators contaminated by influenza laden aerosols can serve as a source of infectious virus for indirect contact transmission. This effort is part of a National Institute for Occupational Safety and Health 5-year multidisciplinary study to determine the routes of influenza transmission in healthcare settings. A coughing simulator was programmed to cough aerosol particles containing influenza virus over a wide concentration range into an aerosol exposure simulation chamber virus/L of exam room air), and a breathing simulator was used to collect virus on either a SM or N95 respirator. Extraction buffers containing nonionic and anionic detergents as well as various protein additives were used to recover influenza virus from the masks and respirators. The inclusion of 0.1% SDS resulted in maximal influenza RNA recovery (41.3%) but with a complete loss of infectivity whereas inclusion of 0.1% bovine serum albumin resulted in reduced RNA recovery (6.8%) but maximal retention of virus infectivity (17.9%). Our results show that a HCW's potential exposure to airborne influenza virus can be assessed in part through analysis of their SMs and N95 respirators, which can effectively serve as personal bioaerosol samplers.

Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics

Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.