Risky Business

When you think of dangerous lines of work, occupations like mining, firefighting and law enforcement come readily to mind. That’s why it is surprising to note that in 2010, the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector — 653,900 cases in all.¹

Healthcare workers face a number of serious safety and health hazards, including physical injury and chemical and biological threats. From bloodborne pathogens and ergonomic pitfalls, to chemical exposures and needlesticks, the healthcare professions can indeed be hazardous to one’s health. This problem has drawn increased attention in recent years; the healthcare workforce was a focus last year of the U.S. Department of Labor’s annual report about workplace injuries and illness. “We remain concerned that more workers are injured in the healthcare and social assistance industry sector than in any other, including construction and manufacturing, and this group of workers had one of the highest rates of injuries and illness at 5.2 cases for every 100 workers,” Labor Secretary Hilda L. Solis stated in a report on the occupational risks in healthcare.²

Back Injuries: A Risk for Nurses

When it comes to back injuries, construction workers, warehouse drivers or delivery personnel might be expected to suffer the highest number of on-the-job injuries. In fact, it is nursing that leads the list with the highest incidence of back injuries, and the second highest number of all types of nonfatal work-related injuries in the U.S.³

A closer look at the day-to-day tasks involved with nursing sheds some light on this statistic: The two main risk factors for back injury among nurses are lifting and transferring patients, and repetitive movements like bed-making. During a typical shift, an average hospital staff nurse will lift 20 patients into bed and transfer five to 10 patients from bed to a chair. Since patients typically weigh in excess of 100 pounds, the load is significantly above the weight that would be considered safe for a typical industrial worker performing this degree of lifting.

“When I was a labor and delivery nurse, my patient and her unborn child went into distress after the epidural had been administered,” says Stephanie McBride, RN. “When the midwife left to get the doctor, I instinctively went to help the patient reposition onto her hands and knees. She was deadweight due to the epidural, and I ended up with two herniated discs and a hairline fracture. The next day, I couldn’t move.” McBride sustained her back injuries two years ago, and although she is in chronic pain, at only 32 years old she is fearful of the potential risks of corrective back surgery. Her injuries forced her to forgo the more physical rigors of the labor and delivery room; she now works as an oncology nurse.

As with many in the hospitality field, bed-making also increases the risks of back injury because of the bending and stretching involved in repetitively changing sheets. The good news is there are several ways that hospitals, care facilities and nursing professionals can minimize the risk of back injury.⁴ These include:

• using lifting assistance devices to help lift and move patients from bed to seat, including gait belts, walkers, bed rails and hydraulic lifts;
• using appropriate equipment to reduce patient handling activities, such as powered beds, height-adjustable chairs, and powered wheelchairs;
• promoting improved and consistent ergonomics training for nurses and health aides to encourage good work postures and proper twisting and/or bending techniques.

Needlesticks and Scalpel Safety

The unfortunate reality is that anyone who works regularly around sharp instruments is at some risk of injury, no matter how many safeguards are in place. Needlestick injuries are a common event in all healthcare environments, particularly when drawing blood, administering an intramuscular or intravenous drug, or performing other procedures involving sharp instruments. These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved sharps containers. Surgical procedures also put healthcare workers at risk of needlesticks; a surgical needle may inadvertently penetrate the glove and skin of the surgeon or assistant. Penetrating accidents of the surgeon or assistant with the scalpel or other sharp instruments also are common threats.

While flesh wounds can be painful and sometimes serious, the real threat with needlesticks is the potential transmission of viruses from the source to the recipient. Generally, needlestick injuries themselves cause only minor bleeding or trauma, but the risk of viral infection remains, especially if the patient is a carrier of hepatitis B (HBV), hepatitis C (HCV) or human immunodeficiency virus (HIV). According to the Occupational Safety and Health Administration (OSHA), approximately eight million healthcare workers are at risk of occupational exposure to bloodborne pathogens.⁵

Diane Mawyer, RN, is someone whose life was forever changed by a needlestick injury that infected her with HCV. She tells her story in a compelling nine-minute video that has beenwidely viewed onYouTube.Although the incident happened more than 20 years ago, Mawyer has endured three organ transplants and still struggles with life-altering health challenges. “When I was exposed, very little was known about HCV and the risks associated with needlestick injuries and exposure to bloodborne pathogens,” said Mawyer. “But with our growing understanding of HCV, it is crucial that we be proactive in screening and diagnosis. If my hepatitis C had been identified earlier, there’s a good chance that my organ transplants could have been avoided.”⁶

According to a 2006 study of needlestick injuries and safety devices, the majority of U.S. nurses surveyed report being accidentally stuck by a needle while working; nearly half (47 percent) of all nurses in the survey were stuck by a contaminated needle. Of the nurses reporting needlesticks, some were stuck multiple times.⁷

“Healthcare workers like Ms. Mawyer are on the frontlines every day looking out for our health and safety, and we need to do more to protect them,” said Murray Cohen, PhD, MPH, CIH, chairman of the Frontline Healthcare Workers Safety Foundation, in an article on safety issues and healthcare workers. “By addressing the need for appropriate prevention measures, disease screening and post-exposure therapy guidelines…, we hope to urge government, private employers and benefit providers to take action to protect workers from the debilitating effects of HCV.”⁸

The Centers for Disease Control and Prevention (CDC) estimates that hospital-based healthcare personnel sustain an average of 1,000 sharps injuries per day.⁹ Scalpel blade injuries account for 7 percent to 8 percent of those injuries.In an article on sharps safety published by the Joint Commission on Accreditation of Healthcare Organizations, Jerry Gervais, CHFM, CHSP, associate director, Standards Interpretation Group of the Joint Commission, said: “It’s very unfortunate that injuries such as these occur, and it’s not just clinicians who are at risk. Other potential victims include maintenance, laundry and housekeeping personnel.”¹⁰

Gervais noted that one of many protective measures that can be implemented to protect healthcare providers includes putting needles and scalpel blades in self-sealing containers and then sending them to an approved medical destruction site regulated by the federal Environmental Protection Agency to ensure they are disposed of properly.

Of course, all the safeguards in the world are no match against medical personnel noncompliance. While the reasons for noncompliance can be varied and complex, Mary J. Ogg, MSN, RN, CNOR, sharps expert with the Association of periOperative Registered Nurses (AORN), said oftentimes physicians may be hesitant to adopt practices that decrease the incidence of sharps injuries if hard numbers supporting best practices are not provided. Ogg notes that AORN developed a 30-slide educational PowerPoint presentation that demonstrates the effectiveness of the practices with supporting data.¹¹ “Surgeons are more receptive to seeing evidence rather than just being told they should do this,” she explained. “The AORN toolkit on sharps injuries and needlesticks also includes a letter from retired surgeon Mark Davis, MD, that explains when a physician ignores best practices for preventing injuries, he or she puts every member of the surgical team at risk.” Ogg recommends using data and testimony from other respected physicians to convince providers that the prevention practices are worthwhile and necessary.

Minimizing Chemical Hazards

Exposure to potentially hazardous chemicals is a fact of life for healthcare workers. Chemicals are encountered in the course of diagnostic and therapeutic procedures; in laboratory work; in preparation and cleanup activities; and sometimes even in emanations from patients. Despite the constant threat of such exposures, this problem has historically received minimal attention from those involved in occupational health and safety research and regulation.

Numerous chemicals found in hospitals may be toxic or irritating to workers who come in contact with them. Chemical exposure can come in the form of airborne dusts, vapors or gases; they may also enter the body by absorption through the skin. Some of the more common potential chemical exposure risks for healthcare workers include formaldehyde used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde and peracetic acid used for sterilization; and numerous other chemicals used in healthcare laboratories. In terms of specific risks, glutaraldehyde is known as a potent sensitizer that causes occupational asthma. Many of the drugs used to treat cancer are themselves known carcinogens. Ethylene oxide, a cold sterilizing agent, is a carcinogen and a reproductive toxin that causes miscarriage. Cleaning agents and materials and their methods of use are increasingly implicated in asthma. Despite the existence of OSHA chemical hazard communications, most healthcare workers are unaware of the risks of these agents and the appropriate control measures needed to prevent injury.¹²

Danger in the Air

The harsh, disinfectant odor common in hospitals is considered a necessary irritant required to keep bacteria at bay. But for those who are exposed to the resulting poor indoor air quality on a regular basis, the longer-term health consequences can be troublesome. Many traditional cleaning products, floor strippers and disinfectants present a variety of human health and environmental concerns, and may contain chemicals that cause cancer, reproductive disorders, respiratory ailments (including occupational asthma), eye and skin irritation, central nervous system impairment, and other human health effects.¹³ In addition, some of these products contain persistent bioaccumulative toxins (PBTs), and are classified as hazardous waste, or otherwise contribute to environmental pollution during their manufacture, use or disposal. Hospitals and clinics hoping to minimize employee exposure to such chemicals are encouraged to explore some of the environmentally friendly options that are becoming increasingly available, especially as “green” cleaning products become more and more mainstream.

According to an abstract published by the U.S. National Library of Medicine National Institutes of Health, decreasing chemical exposure in the healthcare setting will require a multipronged approach. Suggestions include recognizing healthcare as a “high-hazard” employment sector; fortifying voluntary safety guidelines to the level of enforceable regulation; “potent” inspections; treating hazardous pharmaceuticals like the chemical toxicants they are; and protecting healthcare workers at least as well as workers in other high-hazard sectors.¹³