Jack K. Leiss

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

ObjectiveThe 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.MethodsA 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.ResultsThe 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.ConclusionsParamedics 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.

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

BACKGROUND Home care/hospice nurses may be at elevated risk of blood exposure because of the nature of their work and work environment. However, little is known about the incidence of blood exposure in this population. METHODS A mail survey (n = 1,473) was conducted among home care/hospice nurses in North Carolina in 2006. RESULTS The adjusted response rate was 69%. Nine percent of nurses had at least one exposure/year. Overall incidence was 27.4 (95% confidence interval: 20.2, 34.6)/100,000 visits. Nurses who had worked in home care < or =5 years had higher exposure rates than other nurses-seven times higher for needlesticks and 3.5 times higher for non-intact skin exposures. Nurses who worked part time/contract had higher exposure rates than nurses who worked full time-seven times higher for needlesticks and 1.5 times higher for non-intact skin exposures. The rates for part-time/contract nurses with < or =5 years experience were extremely high. Sensitivity analysis showed that it is unlikely that response bias had an important impact on these results. CONCLUSIONS Approximately 150 North Carolina home care/hospice nurses are exposed to blood annually. If these results are representative of other states, then approximately 12,000 home care/hospice nurses are exposed each year nationwide. Improved prevention efforts are needed to reduce blood exposure in home care/hospice nurses. Am. J. Ind. Med. 52:99-104, 2009. (c) 2008 Wiley-Liss, Inc.

Management practices and risk of occupational blood exposure in U.S. paramedics: Needlesticks.

BACKGROUND The purpose of this study was to present risk estimates for needlestick in U.S. paramedics and estimated risk ratios for selected management practices. METHODS A mail survey was conducted among a national sample of U.S. paramedics in 2002-2003. RESULTS The adjusted response rate was 55% (n = 2,664). The overall 12-month risk of needlestick was 6.7% (95% confidence interval, 5.4-7.9). Risk ratios for provision of safety-engineered medical devices and two supervisory behaviors that emphasized safe work practices ranged from 2.5 to 3.2. The protective effect of working in an environment that included both of the supervisory behaviors was greater than the protective effect of always being provided with safety devices. A sensitivity analysis indicated that the risk ratio estimates were unlikely to be inflated by nonresponse bias. CONCLUSIONS These results suggest that greater provision of safety devices and interventions aimed at management practices that promote worker safety could substantially reduce the risk of needlestick among U.S. paramedics.

U.S. Maternally Linked Birth Records May Be Biased for Hispanics and Other Population Groups

PURPOSE We sought to advance understanding of linkage error in U.S. maternally linked datasets and how the error might affect results of studies based on the linked data. METHODS North Carolina birth and fetal death records for 1988-1997 were maternally linked (n=1,030,029). The maternal set probability, defined as the probability that all records assigned to the same maternal set do in fact represent events to the same woman, was used to assess differential maternal linkage error across race/ethnic groups. RESULTS Maternal set probabilities were lower for records specifying Asian or Hispanic race/ethnicity, suggesting greater maternal linkage error for these sets. The lower probabilities for Hispanics were concentrated in women of Mexican origin who were not born in the United States. CONCLUSIONS Differential linkage error may be a source of bias in studies that use U.S. maternally linked datasets to make comparisons between Hispanics and other groups or among Hispanic subgroups. Methods to quantify and adjust for this potential bias are needed.

Safety Climate and Use of Personal Protective Equipment and Safety Medical Devices among Home Care and Hospice Nurses

Abstract: 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.

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 investigators experience, formative research can be an effective means of obtaining that information.