Introduction
The Association of Occupational Health Professionals in Healthcare (AOHP), hereafter sometimes referred to as The Association, is a national association whose members represent thousands of health care workers nationwide. The Association is dedicated to promoting the health and safety of workers in healthcare, and strives to influence legislation, regulations and public policy that positively affect occupational health in healthcare.
The Association conducted a member survey in 2010in an effort to respond to member needs. Revisions were made to the AOHP 2009-11 Public Policy statement based on the results of the survey with the following topics identified as the top public policy issues of concern to AOHP members and were approved by the Executive Board of Directors.
Bloodborne Pathogen Exposure
AOHP advocates for policy that supports a safer environment for employees via the use of safer technology, education, training and prevention regarding sharps injuries. AOHP is also concerned about the underreporting of sharps injuries. The Association continues to advocate for a policy in which individual states remove the current statutory requirement for special written consent for HIV testing to expedite exposure source testing in the case of a blood or body fluid exposure involving a healthcare worker. AOHP is working on these issues in conjunction with key partners such as, Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC).
The National Institute for Occupational Safety and Health (NIOSH) 2004 data indicates that fifty-seven healthcare personnel in the United States have been documented as having seroconverted to HIV following occupational exposures. Twenty-six have developed AIDS. There are another 140 with possible, unconfirmed seroconversion.1
The timely testing of the source patient for HIV is critical to the evaluation and management of a healthcare worker who has sustained a blood or body fluid exposure. This shortens the time before necessary HIV anti-viral prophylaxis is delivered, eliminates the need for follow up testing, and reduces the level of worker anxiety over the exposure.
Many states currently require special written consent with counseling prior to the ordering of HIV tests on any individual in the healthcare system. The CDC revised its recommendation for HIV testing of adults, adolescents, and pregnant women in healthcare settings in 2006 (Recommendation and Reports, September 22, 2006/55 – RR14).
The CDC advocates that HIV screening should be incorporated into the general consent for medical care after the patient is notified that testing will be performed unless the patient declines or opts out. Separate written consent is no longer recommended.
Sharps injures in the healthcare environment is particularly problematic. The CDC advises that “Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, resulting in approximately 385,000 needlesticks and other sharps-related injuries to hospital-based healthcare workers each year. Similar injures occur in other healthcare settings, such as nursing homes, clinics, emergency care services, and private homes. Sharps injuries are primarily associated with occupational transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV), but they have been implicated in the transmission of more than 20 other pathogents.”2 Based on the magnitude of the sharps injuries in the healthcare setting AOHP supports efforts to reduce these types of injuries through a comprehensive approach that includes the development of sharps engineering controls and safer medical devices, injury prevention teams to evaluate sharps injuries, administrative controls, and healthcare worker education.
Safe Patient Handling
AOHP supports efforts to ensure a safer healthcare environment for both the patient and the employee, including utilizing lift/assist devices as the primary method for the prevention of musculoskeletal injuries. More than 40 years of instructing healthcare workers on proper body mechanics has done little to impact injury statistics. For patient transfers, lifts, and repositioning, mechanical equipment must be provided by the facility and used by the caregivers. The Association advocates for regulations, legislation, education, training, research, and prevention activities as related to safer patient handling activities and methodologies. AOHP will work to influence both state and national legislation as it relates to Safe Patient Handling.
Back injuries and other musculoskeletal disorders related to patient handling are the leading cause of workplace disability for nurses and other direct patient care providers. Each year approximately 40,000 nurses report work-related back pain. This represents over three-quarters of a million lost workdays annually due to back injuries among nurses. Many of these injuries are related to manual patient transfer and repositioning tasks.
Nursing aides, orderlies, and attendants had the highest rate of injuries and illnesses with 456 per 10,000 full-time workers3 (Source: Bureau of Labor Statistics. USDL-10-1546, November 9, 2010). This represents 50,620 days-away-from-work, which is a 12% increase in the rate compared to 2008. These groups continue to have a high incident rate second to police and sheriff patrol officers at 602 per 10,000 full-time workers.
Respiratory Protection
AOHP supports efforts to ensure a safer workplace for employees by utilizing systems and processes that are evidence-based and supported through research. The Association advocates for increased research, training and education related to respiratory protection from tuberculosis (TB) and other airborne respiratory transmissible diseases. With AOHP and NIOSH’s Memorandum of Understanding, a collaborative relationship has developed with the National Personal Protective Technology Lab (NPPTL) in Pittsburgh, PA where groundbreaking healthcare related research is being conducted on the need for annual fit testing, general respirator use, respirator use in pandemics and other areas related to respirator use in healthcare. AOHP strongly supports NIOSH’s effort to scientifically determine the need for annual fit testing, as well as training and education regarding respiratory protection according to OSHA’s Respiratory Protection Standard4 and the CDC’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.5
One respiratory transmissible disease, tuberculosis, continues to be an ongoing infectious disease issue in the healthcare setting. Diagnosis of the disease is most important in preventing its spread, along with regular screening of healthcare workers. The current ruling from OSHA is that the particulate respirator that is recommended for personal protection against TB is included with the Federal Register for General Industry Respiratory Protection standard. This regulation requires annual fit testing and education for all respirator wearers.
Workplace Violence
Workplace violence can range from a definition of offensive or threatening language to homicide. NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.6 According to the U.S. Bureau of Labor Statistics for the period of 1995-2004, assaults (usually by one of their patients) account for 7% of the workplace injuries to nursing, psychiatric, and home health aides. In contrast, among all occupations, 1 percent of the injuries were the result of assaults. In addition, nursing, psychiatric, and home health aides represented nearly 30 percent of the total number of workplace assaults during the 10-year period.7 Healthcare workers have a high risk for workplace violence, especially direct care workers, due to the populations they serve who may have altered mental status related to the influence of drugs and alcohol, psychiatric disorders, pain, multiple psychosocial stressors, or grief.
AOHP supports implementing comprehensive violence prevention programs that are risk specific to the healthcare organization or facility. A comprehensive violence prevention program must include a written program, management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting. Periodically, it is critical that healthcare organization’s violence prevention programs be evaluated and updated. These violence prevention programs need to include addressing co-worker or lateral violence as well. Case reports of prevention strategies that have reduced workplace violence in the healthcare setting include installing metal detectors at Emergency Department entrances, establishing a violent patient date base, and limiting visitor access to specific floors or areas via a GPS tracking badge.5 AOHP supports and encourages healthcare organizations to endeavor to protect their patients, employees, and visitors from acts of violence, as well as continuing further research on prevention strategies for workplace violence.
Through AOHP’s Memorandum of Understanding with NIOSH, AOHP is participating in the development of an on-line educational program for nurses that will share best practices to reduce workplace violence.
AOHP is dedicated to promoting the health and safety of workers in healthcare. This is accomplished through:
Advocating for employee health and safety
Occupational health education and networking opportunities
Health and safety advancement through best practice and research
Partnering with employers, regulatory agencies and related associations
For more information please call AOHP headquarters at (800) 362-4347 or e-mail info@aohp.org.
Bibliography
1 "Worker Health Chartbook 2004 - Appendix A - Surveillance of Health Care Workers with AIDS, NIOSH Publication No. 2004-146." Centers for Disease Control and Prevention. NIOSH, 2004. Web. 14 Dec. 2010. http://www.cdc.gov/niosh/docs/2004-146/
appendix/ap-a/ap-a-18.html
2 "CDC - Sharps Safety for Healthcare Settings." Centers for Disease Control and Prevention. Web. 18 Jan. 2011. http://www.cdc.gov/sharpssafety/#
3 "Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2009, USDL-10-1546." U.S. Bureau of Labor Statistics. 9 Nov. 2010. Web. 14 Dec. 2010. http://www.bls.gov/news.release/osh2.nr0.htm.
5 ”Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005”, CDC, Morbidity and Mortality Weekly Report, December 30, 2005 / Vol. 54 / No. RR-17. Web 14 Dec. 2010.
http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf
6 "CDC - NIOSH Publications and Products - Violence Occupational Hazards in Hospitals (2002-101)." Centers for Disease Control and Prevention. DHHS (NIOSH), Apr. 2002. Web. 14 Dec. 2010. http://www.cdc.gov/niosh/docs/2002-101/
7 "Occupational Injuries, Illnesses, and Fatalities among Nursing, Psychiatric, and Home Health Aides, 1995-2004." U.S. Bureau of Labor Statistics. 30 June 2006. Web. 14 Dec. 2010. http://www.bls.gov/opub/cwc/sh20060628ar01p1.htm
