Non-hospital based registered nurses and the risk of bloodborne pathogen exposure

Underreporting of workers' injuries or illnesses and contributing factors: a systematic review

BACKGROUND

Accurate identification of work-related health problems is important to understand workplace safety issues and develop appropriate interventions. Although workers' reporting of work-related injuries or illnesses is the very first step of the reporting process, many workers may encounter challenges in reporting them to their management or workers' compensation (WC) programs. This systematic review aimed to identify the level of workers' underreporting of work-related injuries and illnesses and the contributing factors and reasons for underreporting among US workers.

METHODS

This study searched PubMed (Medline), PsycINFO (ProQuest), CINAHL (EBSCOhost), EMBASE (Embase.com), and Social Science Citation Index (Web of Science) using search terms related to underreporting of work-related injury or illness.

RESULTS

Twenty studies (17 quantitative and three mixed methods studies) were identified. The studies investigated reporting to management (n = 12), WC programs (n = 6), multiple organizations (n = 1), and not specified (n = 1). The timeframe used to measure reporting prevalence varied from three months to entire careers of workers, with the most common timeframe of 12 months. This review indicated that 20-91% of workers did not report their injuries or illnesses to management or WC programs. From quantitative studies, contributing factors for injury or illness underreporting were categorized as follows: injury type and severity, sociodemographic factors (e.g., age, gender, education, and race/ethnicity), general health and functioning, worker's knowledge on reporting, job and employment characteristics (e.g., work hour, job tenure, work shift, type of occupation, and physical demand), psychosocial work environment (e.g., supervisor support, coworker support, and safety climate), and health care provider factors. From the review of qualitative studies, the reasons for underreporting included the following: fear or concern, cumbersome time and effort in the reporting process, lack of knowledge regarding reporting, perceptions of injuries as not severe or part of the job, and distrust of reporting consequences.

CONCLUSIONS

The review findings indicated that low wage earners, racial/ethnic minority workers, and workers who perceive a poor psychosocial work environment encounter more barriers to reporting a work-related injury or illness. This review also identified variations in the measurement of work-related injury reporting across studies and a lack of standardized measurement.

TRIAL REGISTRATION

The review was registered in the PROSPERO, an international database of prospectively registered systematic reviews in health and social care (CRD42021284685).

Shift work organization on nurse injuries: A scoping review

BACKGROUND

Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety.

OBJECTIVE

To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse.

METHODS

A scoping review was conducted using search results from five bibliographic databases.

RESULTS

Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes.

CONCLUSIONS

Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Urinary catheter policies in home healthcare agencies and hospital transfers due to urinary tract infection

BACKGROUND

Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home healthcare (HHC) patients, particularly among patients with urinary catheters.

METHODS

We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies' urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals, and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode.

RESULTS

Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (P < .05).

CONCLUSION

Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.

Prevalence and influencing factors of psychological distress among nurses in sichuan, china during the COVID-19 outbreak: A cross-sectional study

BACKGROUND

The COVID-19 pandemic has spread across the world. Nurses have inevitably been influenced by it.

PURPOSE

To investigate the prevalence and influencing factors of psychological distress among nurses in Sichuan, China over the COVID-19 outbreak.

METHODS

This study used a cross-sectional survey design. Thousand eight hundred and seventy nurses who worked in COVID-19-designated hospitals participated in the study during the pandemic. Data was collected online between February 8 and February 13, 2020. The self-designed General Information Questionnaire, the General Health Questionnaire-12, the Perception of Hospital Safety Climate Scale, and the Simplified Coping Style Questionnaire were used. The binomial logistic regression model was applied to assess the association between psychological distress and potential explanatory variables.

FINDINGS

At the beginning of the epidemy of the COVID-19 outbreak, 12% of nurses were found to experience psychological distress. The main influencing factors were personal precautionary measures at work, discomfort caused by protective equipment, perception of the hospital safety climate, coping style, and professional title.

CONCLUSIONS

In the pandemic, wearing protective equipment correctly, a safe hospital climate, and positive coping style for nurses could be beneficial for nurses' mental health. Nurse managers should take measures to build a safe hospital climate.

The state of infection prevention and control at home health agencies in the United States prior to COVID-19: A cross-sectional study

BACKGROUND

Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies.

OBJECTIVES

In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic.

DESIGN

Cross-sectional study.

SETTING/PARTICIPANTS

Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019.

METHODS

Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies.

RESULTS

35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique.

CONCLUSIONS

Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic.

Factors influencing precautions against antineoplastic drug exposure among nurses and nurse assistants in Thailand

BACKGROUND

Antineoplastic drugs (AD) are important chemical risks for healthcare workers. Precautions against AD exposure include the use of appropriate personal protective equipment (PPE). Evaluation of PPE usage during patient care processes has not been reported in Thailand. We aimed to evaluate the level of PPE usage and factors predicting PPE usage among nurses and nurse assistants in Thailand.

METHODS

A cross-sectional survey was conducted in a university hospital and two general hospitals. The questionnaires covered demographic characteristics, self-reported use of PPE and 7 predictive factors. Mixed-effects modeling was used to determine the association between standardized score of predictive factors and PPE usage score.

RESULTS

The response rate was 78.6% and 884 participants were left for analysis after data cleaning. Among nurses (n = 499), higher PPE usage score was associated with self-efficacy (β = 0.28, 95% CI 0.21, 0.34), workplace safety climate (β = 0.27, 95% CI 0.20, 0.34), and conflict of interest (β = - 0.07, 95% CI - 0.14, - 0.01). Among nurse assistants (n = 385), higher PPE usage score was associated with self-efficacy (β = 0.27, 95% CI 0.18, 0.36), interpersonal influence (β = 0.14, 95% CI 0.04, 0.24), workplace safety climate (β = 10.29, 95% CI 0.19, 0.38), and conflict of interest (β = - 0.14, 95% CI - 0.24, - 0.03).

CONCLUSIONS

Several factors were associated with PPE usage among nurses and nurse assistants. Improved PPE usage against AD can be promoted through interventions that modify those factors.

Assessment of Health Workers’ Knowledge, Beliefs, Attitudes, and Use of Personal Protective Equipment for Prevention of COVID-19 Infection in Low-Resource Settings

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious disease with a potential for healthcare workers (HCWs) getting infected due to inadequate protection while attending to patients. Effective use of personal protective equipment (PPE) is key to mitigating the spread of SARS-CoV-2 infection in healthcare settings. Hence, there is a need to understand HCWs’ use of PPE in resource-limited settings and how closely the currently recommended guidelines for PPE are followed. This study assessed the HCWs’ knowledge about, attitudes towards, beliefs on, and use of PPE to prevent SARS-CoV-2 infection in a resource-limited setting. Methods. This cross-sectional study was conducted in April 2020 in Southwest and Northwest Nigeria. The selection of participants was performed via the snowball sampling technique using a 33-item, web-based, self-administered questionnaire via a social media network. We obtained relevant sociodemographic data and information on participants’ occupations and knowledge about, attitudes towards, beliefs on, and use of PPE. We analysed the data using SPSS version 23.0 for Windows (IBM, Armonk, New York, USA). A p values <0.05 were considered statistically significant. Results. A total of 290 subjects responded to the questionnaire, and 18 (6.2%) were excluded because of incomplete data. The mean age of the respondents was 32.3 ± 9.9 years. There were 116 males (42.6%). The majority of the respondents were medical doctors (114, 41.9%), followed by nurses and clinical students. Of the 272 respondents in this survey, only 70 (25.7%) had adequate knowledge about PPE. Of the respondents who presumed they had adequate knowledge about donning and doffing PPE, 94 (56%) were incorrect. The predictors of good knowledge were ages younger than 45 years (p=0.046) and practice location (p=0.009). Conclusion. This study showed that HCWs’ knowledge about, attitudes towards, and beliefs on PPE and their PPE skill in practice in Nigeria were remarkably poor. There is an urgent need for nationwide practical training on PPE use to curtail the spread of SARS-CoV-2 infection among HCWs.

Factors associated with physicians' behaviours to prevent needlestick and sharp injuries

OBJECTIVE

Needlestick and sharp injuries (NSIs) experienced by physicians have been identified as a major occupational hazard. Blood-borne pathogens resulting from the NSIs experienced by physicians pose severe physical and psychological threats to them, as well as people who are around them. However, there is little research focusing on physicians' behaviours to prevent NSIs. In the present study, we investigated the roles of safety climate, job demands experienced by physicians, and physicians' self-efficacy in affecting physicians' behaviours to prevent NSIs.

METHODS

401 physicians from four teaching hospitals in Northern Taiwan were recruited to participate in an anonymous survey. Among them, 189 physicians returned the completed survey with a response rate of 47.1%.

RESULTS

Overall, respondents reported frequently engaging in NSI prevention behaviours. As expected, safety climate in hospitals and physicians' self-efficacy to prevent NSIs were significantly related to their behaviours to prevent NSIs (r = 0.22 and r = 0.33, respectively). The moderating analysis also revealed that physicians with high self-efficacy tended to engage in NSI prevention behaviours regardless of levels of job demand they experienced. In contrast to our expectation, however, physicians with low self-efficacy engaged in more NSI prevention behaviours when job demands were high than when the demands were low.

CONCLUSIONS

Our findings show the important roles safety climate, job demands and self-efficacy play in shaping physicians' NSI prevention behaviours. Hospitals may consider improving safety climate via strengthening management commitments to NSIs prevention, reducing job demands by training physicians to proactively redesign their own jobs, and increasing physicians' self-efficacy via well-designed skill-based training.

Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs

PURPOSE

To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use.

PARTICIPANTS & SETTING

27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States.

METHODOLOGIC APPROACH

This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument.

FINDINGS

Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high.

IMPLICATIONS FOR NURSING

Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.

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.

Testing an Intervention to Decrease Healthcare Workers' Exposure to Antineoplastic Agents

PURPOSE/OBJECTIVES

To develop and test a worksite intervention that protects healthcare workers who handle antineoplastic drugs from work-related exposures. 
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DESIGN

Intervention study. 
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SETTING

A university hospital in a large midwestern metropolitan area and its outpatient chemotherapy infusion clinic.
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SAMPLE

163 staff (nurses, pharmacists, and pharmacy technicians) who work with antineoplastic agents.
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METHODS

A self-report survey measured workplace and individual factors to assess use of personal protective equipment (PPE). Wipe samples were tested for surface contamination. An intervention incorporating study findings and worker input was developed.
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MAIN RESEARCH VARIABLES

PPE use was the dependent variable, and the independent variables included knowledge of the hazard, perceived risk, perceived barriers, interpersonal influence, self-efficacy, conflict of interest, and workplace safety climate. 
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FINDINGS

PPE use was lower than recommended and improved slightly postintervention. Self-efficacy and perceived risk increased on the post-test survey. Chemical residue was found in several areas. Awareness of safe-handling precautions improved postintervention. The unit where nurses worked was an important predictor of safety climate and PPE use on the pretest but less so following the intervention. 
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CONCLUSIONS

Involving staff in developing an intervention for safety ensures that changes made will be feasible. Units that implemented workflow changes had decreased contamination. 
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IMPLICATIONS FOR NURSING

Worksite analysis identifies specific targets for interventions to improve antineoplastic drug handling safety.

Occupational Exposure to Antineoplastic Agents

Approximately 8 million health care workers are unnecessarily exposed to highly toxic drugs used to treat cancer; antineoplastic drugs can contribute to negative health effects for these workers. The drugs have been detected in the urine of workers and on the floors and counters of worksites. Safety precautions that could reduce the risk of exposure are underutilized. This cross-sectional study of 163 oncology health care workers used a survey to measure workplace and individual factors, and environmental sampling to measure surface contamination. The study objective was to identify potential exposures to antineoplastic drugs and factors influencing safety behavior. Personal protective equipment (PPE) use was lower than recommended; unit of employment was significantly associated with PPE use. Chemical residue from antineoplastic drugs was found, revealing potential exposures. Workplace safety must be a higher organizational priority. The contamination of common work areas where PPE use is not expected was of utmost concern.

Scheduling and shift work characteristics associated with risk for occupational injury in newly licensed registered nurses: An observational study

BACKGROUND

Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics.

OBJECTIVE

To describe newly licensed nurses' shift work characteristics and determine the association between shift type and scheduling characteristics and nurse injury, before and after adjusting for individual and combined effects of demographics, external context, organizational context, and work context, following the Organization of Work model.

DESIGN

This study is a secondary analysis of a nationally representative survey of newly licensed registered nurses using a cross-sectional design.

PARTICIPANTS

The analytic sample includes 1744 newly licensed registered nurses from 34 states and the District of Columbia who reported working in a hospital and were within 6-18 months of passing their state licensure exam at the time of survey administration.

METHODS

Descriptive statistics were calculated, followed by bivariate and multivariate Poisson regression models to assess the relationship between shift type and scheduling characteristics and nurse injury. Lastly, full models with the addition of demographics, external context, organizational context, and work context variables were calculated.

RESULTS

The majority (79%) of newly licensed nurses worked 12-h shifts, a near majority worked night shift (44%), and over half (61%) worked overtime (mandatory or voluntary) weekly. Nurses working weekly overtime were associated with a 32% [incidence rate ratio (IRR) 1.32, CI 1.07-1.62] increase in the risk of a needle stick and nurses working night shift were associated with a 16% [IRR 1.16, CI 1.02-1.33] increase in the risk of a sprain or strain injury.

CONCLUSIONS

Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics. The findings warrant further study given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity.

Understanding sharps injuries in home healthcare: The Safe Home Care qualitative methods study to identify pathways for injury prevention

Background

Home healthcare is one of the fastest growing sectors in the United States. Percutaneous injuries from sharp medical devices (sharps) are a source of bloodborne pathogen infections among home healthcare workers and community members. Sharps use and disposal practices in the home are highly variable and there is no comprehensive analysis of the system of sharps procurement, use and disposal in home healthcare. This gap is a barrier to effective public health interventions. The objectives of this study were to i) identify the full range of pathways by which sharps enter and exit the home, stakeholders involved, and barriers for using sharps with injury prevention features; and ii) assess the leverage points for preventive interventions.

Methods

This study employed qualitative research methods to develop two systems maps of the use of sharps and prevention of sharps injuries in home healthcare. Twenty-six in-depth interview sessions were conducted including home healthcare agency clinicians, public health practitioners, sharps device manufacturers, injury prevention advocates, pharmacists and others. Interview transcripts were audio-recorded and analyzed thematically using NVIVO qualitative research analysis software. Analysis of supporting archival material also was conducted. All findings guided development of the two maps.

Results

Sharps enter the home via multiple complex pathways involving home healthcare providers and home users. The providers reported using sharps with injury prevention features. However, home users’ sharps seldom had injury prevention features and sharps were commonly re-used for convenience and cost-savings. Improperly discarded sharps present hazards to caregivers, waste handlers, and community members. The most effective intervention potential exists at the beginning of the sharps systems maps where interventions can eliminate or minimize sharps injuries, in particular with needleless treatment methods and sharps with injury prevention features. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential.

Conclusions

Sharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.

Psychosocial work characteristics and needle stick and sharps injuries among nurses in China: a prospective study

PURPOSE

Psychosocial work characteristics may be associated with needle stick and sharps injuries (NSIs) among nurses. The current evidence is, however, sparse, inconclusive, and mainly limited to cross-sectional investigations. We aimed to contribute prospective data.

METHODS

We conducted a prospective study among 1,791 female hospital nurses from China. At baseline and at a 1-year follow-up, fourteen psychosocial work characteristics were assessed by the short Copenhagen Psychosocial Questionnaire. At follow-up, any NSI in the workplace during the previous year was measured by participants' self-reports. We quantified associations between (1) psychosocial work characteristics at baseline and NSIs at follow-up by multivariate relative risks (Poisson regression) and (2) NSIs reported at follow-up with psychosocial work characteristics at follow-up (multivariate linear regression, among others, adjusted for psychosocial work characteristics at baseline).

RESULTS

The only psychosocial work characteristic associated with a slightly increased risk of subsequent NSIs was quantitative demands. Examining the opposite direction of effect, we found that NSIs during the year preceding the follow-up were associated with slightly worse ratings of seven psychosocial work characteristics at follow-up (i.e., influence at work, meaning of work, commitment to the workplace, quality of leadership, social support, social community at work, and job insecurity).

CONCLUSIONS

Overall, our study does not provide compelling evidence for an association of psychosocial work characteristics and subsequent occurrence of NSIs. By contrast, experience of NSIs may predict less favorable perceptions of psychosocial work characteristics.

Needlestick Injuries in Nursing Homes: The Prominent Role of Insulin Pens

Causes and circumstances related to 162 needlestick injuries in nursing homes were analyzed. In addition to nurses, geriatrics helpers were found to be an important occupational group at risk. Insulin pens were the most frequent cause of needlestick injuries among nursing personnel. Insulin pens are a major instrument involved with unsafe needle-handling practices.

Piecewise exponential models to assess the influence of job-specific experience on the hazard of acute injury for hourly factory workers

Background

An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.

Methods

Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.

Results

We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.

Conclusions

Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models.

Health belief model to predict sharps injuries among health care workers at first level care facilities in rural Pakistan

BACKGROUND

We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan.

METHOD

HCWs working at public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic(NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression.

RESULTS

From 365 clinics, 485 HCWs were interviewed. Overall annual rate of SIs was 192/100 HCWs/year; 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93; 95%CI: 0.89-0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02; 95%CI: 1.36-2.98) licensed (RR: 2.86; 9%CI: 1.81-4.51) or non-licensed assistant (RR: 2.78; 95%CI: 1.72-4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06; 95%CI: 1.03-1.08), and compliance with UPs scores (RR: 0.93; 95%CI: 0.87-0.97) were significant predictors of SIs.

CONCLUSION

Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs.

Factors influencing oncology nurses' use of hazardous drug safe-handling precautions

PURPOSE/OBJECTIVES

To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions.

DESIGN

Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers.

SETTING

Mailed invitation to oncology centers across the United States.

SAMPLE

165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy.

METHODS

Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis.

MAIN RESEARCH VARIABLES

Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate.

FINDINGS

Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use.

CONCLUSIONS

Circumstances in the workplace interfere with nurses' use of HD precautions.

IMPLICATIONS FOR NURSING

Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.

Biological risk and occupational health

Many work activities include hazards to workers, and among these biological risk is particularly important, mostly because of different types of exposure, contact with highly dangerous agents, lack of limit values able to compare all exposures, presence of workers with defective immune systems and therefore more susceptible to the risk. Bioaerosols and dust are considered important vehicles of microganisms at workplaces and interaction with other occupational agents is assumed. Moreover, biological risk can be significant in countries with increasing economic development or particular habits and some biological agents are also classified as carcinogenic to human. Specific emerging biological risks have been recently pointed out by Risk Observatory of the European Agency for Safety and Health at work, and we must consider the worker's attitude and behaviour, influenced by his own perception of risk more than his real knowledge, that could over-underestimate the risk itself. Therefore, biological risk at work requires a complex approach in relation to risk assessment and risk management, made more difficult due to the wide variety of biological agents, working environments and working techniques that can determine the exposures.

Evaluation of a new safety peripheral IV catheter designed to reduce mucocutaneous blood exposure

OBJECTIVES

We evaluated performance and clinical acceptability of a new peripheral intravenous catheter (PIVC) designed to reduce blood exposure.

METHODS

A two phased, unblinded, randomized controlled trial was conducted at a clinical research center in New Jersey, USA. In Phase 1, clinicians were asked to evaluate two devices: a PIVC with blood control (BD Insyte Autoguard * BC [Blood Control] Shielded IV Catheter), and a reference conventional PIVC (BD Insyte Autoguard Shielded IV Catheter). In Phase 2, clinicians compared two insertions of the investigational PIVC with blood control (PIVC-BC); one with venous compression and one without. The PIVC-BC was evaluated for superiority to the conventional PIVC with regard to blood exposure and for equivalence in general performance characteristics.

RESULTS

Seventy-eight clinicians (mean age: 41.4 years; 89.7% female) and 234 healthy volunteers (mean age: 40.2 years; 61.5% female) were enrolled. Blood leakage occurred significantly more in the conventional PIVC group (39.1%) as compared to the PIVC-BC group (2.0%) (difference: 37.1% [95% CI: 28.8%; 45.15%]). Blood leakage rates for the PIVC-BC with or without use of venous compression were similar, 2.6% and 1.3% respectively (difference: 1.3% [95% CI: -7.8%; 4.7%]). A total of 98.7% of clinicians rated the PIVC-BC as clinically acceptable compared to 89.6% with the reference PIVC (difference: -9.1; 95% CI: -18; -1.5%) and 98.7% agreed it replaced the need for venous compression during catheter insertion (95% CI: 92.8%; 100%). Although the inability to blind clinicians to the investigational product was a potential source of bias, this was unlikely to affect assessments of observed blood leakage.

CONCLUSIONS

The PIVC with blood control demonstrated reduced blood leakage during insertion and was rated no different for clinical acceptability and insertion performance compared to the conventional PIVC. Clinicians agreed that the new design replaced the need for venous compression to control blood flow during IV catheter insertion.

Biological risk in nursing care provided in family health units

There is very frequent exposure to potentially contaminated material in procedures performed by nursing professionals. This exploratory and descriptive study characterizes the potential risk of biological exposure in procedures performed by nursing professionals in ten Family Health units in São Carlos-SP, Brazil. We observed 238 procedures involving potential risk of contact with biological material, in which more than 90% involved the use of needles. The average rates of adherence to standard precautions were: 27.9% hand washing prior to procedures; 41.4% use of gloves; and 88.8% adequate disposal of piercing and cutting instruments. These professionals are subject to risks similar to those which hospital workers are also subjected, because they have a high risk of blood exposure and the frequency with which they handle needles is very high.

Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan

To investigate the interactions between safety climate, psychosocial issues and Needlestick and Sharps Injuries (NSI), a cross-sectional study was undertaken among nurses at a university teaching hospital in Japan (89% response rate). NSI were correlated with various aspects of hospital safety climate including supporting one another at work, the protection of staff against blood-borne diseases being a high management priority, managers doing their part to protect staff from blood-borne disease, having unsafe work practices corrected by supervisors, having the opportunity to use safety equipment to protect against blood-borne disease exposures, having an uncluttered work area, and having minimal conflict within their department. In conclusion, this study has demonstrated the importance of hospital safety climate in Japanese health care practice, particularly its relationship with NSI. Although the provision of safer devices remains critical in preventing injuries, ensuring a positive safety climate will also be essential in meeting these important challenges for nurses' occupational health.

Sharps injuries and other blood and body fluid exposures among home health care nurses and aides

OBJECTIVES

We quantified risks of sharp medical device (sharps) injuries and other blood and body fluid exposures among home health care nurses and aides, identified risk factors, assessed the use of sharps with safety features, and evaluated underreporting in workplace-based surveillance.

METHODS

We conducted a questionnaire survey and workplace-based surveillance, collaborating with 9 home health care agencies and 2 labor unions from 2006 to 2007.

RESULTS

Approximately 35% of nurses and 6.4% of aides had experienced at least 1 sharps injury during their home health care career; corresponding figures for other blood and body fluid exposures were 15.1% and 6.7%, respectively. Annual sharps injuries incidence rates were 5.1 per 100 full-time equivalent (FTE) nurses and 1.0 per 100 FTE aides. Medical procedures contributing to sharps injuries were injecting medications, administering fingersticks and heelsticks, and drawing blood. Other contributing factors were sharps disposal, contact with waste, and patient handling. Sharps with safety features frequently were not used. Underreporting of sharps injuries to the workplace-based surveillance system was estimated to be about 50%.

CONCLUSIONS

Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. Improvements in hazard intervention are needed.

Organizational climate and its relationship with needlestick and sharps injuries among Japanese nurses

BACKGROUND

Although certain aspects of organizational climate have been shown to influence needlestick and sharps injuries (NSI) among nurses, this issue has not been adequately investigated in Japan.

METHODS

Our study involved a modified version of the Hospital Safety Climate Scale, which was distributed to a large cross section of nurses in a Japanese teaching hospital.

RESULTS

Various aspects of safety climate were associated with a reduced NSI risk, such as being involved in health and safety matters (odds ratio [OR], 0.13; 95% confidence interval [CI]: 0.02-0.65) and being properly trained in risk control procedures (OR, 0.32; 95% CI: 0.12-0.78). Nurses working in departments in which health and safety information was readily available were more likely to report any NSI they sustained (OR, 4.91; 95% CI: 1.30-18.51), whereas nurses working in departments with minimal conflict were less likely to underreport their NSI (OR, 0.45; 95% CI: 0.22-0.87).

CONCLUSION

Overall, this study suggests that hospital safety climate has an important influence on NSI injury rates and reporting behavior among Japanese nurses. Given the multifaceted nature of identified risk, a comprehensive approach to infection control is clearly required and one that encompasses preventive strategies in both the cultural and physical domains.

The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector

BACKGROUND

Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted.

METHODS

A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure.

RESULTS

Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others.

CONCLUSION

The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

Menstrual disorders and their influence on low back pain among Japanese nurses

An increasing body of evidence now suggests that menstrual disorders may influence the development of Low Back Pain (LBP) among women of reproductive age. To investigate this issue in Japan, we conducted a large cross-sectional survey of female nurses from a university teaching hospital during 2008. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI: 1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, our study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.

The national study to prevent blood exposure in paramedics: rates of exposure to blood

OBJECTIVE

The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers.

METHODS

A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately.

RESULTS

The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers.

CONCLUSIONS

Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.

Organizational climate and nurse health outcomes in the United States: a systematic review

Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.