Angela Laramie

There's no place like home: a qualitative study of the working conditions of home health care providers.

Objective: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. Methods: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. Results: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. Conclusions: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

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.

Occupational Exposure of Health Care Personnel to Hepatitis B and Hepatitis C: Prevention and Surveillance Strategies

Ensuring the safety of personnel working in health care environments can be challenging and requires a multifaceted approach to target reductions in occupational exposures to blood-borne pathogens, such as hepatitis B or hepatitis C. This article reviews the epidemiology of occupational exposures to hepatitis B and hepatitis C in health care personnel in hospital settings. The nature and likelihood of risk to health care personnel are evaluated along with estimates of seroconversion risk. The review focuses on prevention programs and available surveillance programs to aid in monitoring and reducing occupational exposures to blood-borne pathogens.

Occupational health of home care aides: results of the safe home care survey

Objectives In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. Methods HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides’ OSH experiences. Results The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. Conclusions The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

OBJECTIVE Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (SIs). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007. DESIGN Prospective surveillance. SETTING Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health. PARTICIPANTS Employees of acute care hospitals who reported SIs to their employers. METHODS Data on SIs in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends. RESULTS During 2002-2007, 16,158 SIs among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P < .001). Rates declined significantly among nurses (-7.2% per year; P < .001) but not among physicians (-0.9% per year; P = .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period. CONCLUSION SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

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

BackgroundHome 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.MethodsThis 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.ResultsSharps 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.ConclusionsSharps 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.

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

HighlightsQuantifies risks and risk factors for sharps injuries (SI) in home care (HC) aides.Shows that SI are a serious HC aide hazard.Strongest predictors of SI include caring for physically aggressive clients.HC aides who are men, immigrants, or client‐hired have higher SI risks.Findings can support policies to improve HC and medical practices. 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.

Procedure trays: a call to action for sharps safety.

www.nursing2009.com January | Nursing2009 | 13 MANY HOSPITALS ARE ROUTINELY offered prepackaged procedure trays containing sharp devices that conflict with mandates of the Occupational Safety and Health Administration Bloodborne Pathogens (BBP) standard, which requires hospitals to systematically evaluate and select safety products whenever possible. These trays may also be in conflict with state regulations and with the hospital’s own sharps injury prevention efforts. (See Stuck on significant statistics.) In this article, we’ll give you an overview of the problem based on our investigation, highlight the need for tray suppliers to provide products that offer safety and regulatory compliance at a reasonable cost, and suggest actions you can take. The terms kit, tray, and pack are used interchangeably to describe a unit supply of medical devices and supplies for conducting a particular medical procedure. For simplicity, we’ll refer to these supplies as trays in this article.