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Help Set the Research Agenda for the Healthcare and Social Assistance Sector

Posted on by LT Megan Casey, RN, BSN, MPH

NIOSH wants to hear from you on how to improve workplace health and safety in the Healthcare and Social Assistance industry sector. Your insights will be used to inform the National Occupational Research Agenda (NORA). NORA is a partnership program to stimulate innovative research and improved workplace practices in occupational safety and health.  Since 1996, NORA has brought together diverse parties to identify the most critical issues in workplace safety and health and then work together to develop goals and objectives to address these needs.  Participation in NORA includes stakeholders from universities, large and small businesses, worker organizations, professional societies, and government agencies.

As we look forward to the third decade of NORA, we want to hear from all interested individuals and stakeholders to tell us what they think are the most pressing needs to improve occupational health and safety in the Healthcare and Social Assistance Sector. This broad industry sector includes workers in outpatient healthcare services; hospitals; nursing and residential care facilities; home care; animal care and veterinary services; child day care services; community food or housing programs, and individual and family services for youth, elderly, and persons with disabilities.

We want to hear your unique insights into this diverse industry sector. Anyone who is interested is encouraged to submit their input, including workers, employers, researchers, and professionals in occupational safety and health.

  • What areas of this industry sector should we focus on in the third decade of NORA?
  • What injuries and illnesses are of particular concern to workers in the Healthcare and Social Assistance industry sector?
  • What workplace interventions have been shown to be effective in this sector?
  • What projects or initiatives do you think would have the greatest impact on workers in the Healthcare and Social Assistance sector?

We encourage all interested individuals and stakeholders to submit their ideas, input and insights in the comment box below. If you prefer to communicate with us directly, please email your comments to: NIOSH_HCSA@cdc.gov. We would appreciate all comments before August 31, 2016 to inform our planning for the third decade of NORA.

Please feel free to forward this post to anyone who would like to contribute.

LT Megan Casey, RN, BSN, MPH, is a Nurse Epidemiologist in the NIOSH Respiratory Health Division.

 

Posted on by LT Megan Casey, RN, BSN, MPH

21 comments on “Help Set the Research Agenda for the Healthcare and Social Assistance Sector”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    In my work collecting state CFOI data there are two areas of concern thus far: the prevalence of fatalities in the farming and forestry industries and secondly, the increasing rate of at-work suicides across all sectors.

    In farming, prevention techniques that focus on reaching farmers through an online app such as the FARM_HAT tool (available through Penn State, I beliieve: http://extension.psu.edu/business/ag-safety/farmhat) and funding of safety grants for grain bin harness installation needs attention.

    The suicide rate requires deeper study: perhaps of the effectiveness of employee wellness programs, employER awareness training, outreach to small business owners.

    Thank you,
    Nancy Reeck

    These are great insights and we have sent them to our partners in the Agriculture, Forestry and Fishing Sector Council, as I’m sure they will be interested in these topic areas. Suicide and mental health issues are a concern for us the Healthcare and Social Assistance Sector, especially among veterinarians and other groups. Thank you for your insights and we will use them in our planning for the 3rd Decade of NORA.

    I have found a lack of guidelines for handling the new/old
    Virus,etc that have came to light for the first responders,sugery,ER, etc.
    There is a strong need for clear lines per area listed for an over all safety of the personal and public.
    There should be a clear penalty of failure to follow the set guides.

    Thank you so much for your thoughts. There are certainly challenges when it comes to communicating infection control practices for emerging infectious diseases to all stakeholders. While NIOSH does not provide regulatory oversight, we plan to continue working closely with our partners at OSHA in the 3rd Decade of NORA.

    These comments are regarding the sectors mentioned in this request – health care and social assistance workers. Here are some ideas from my recent work.

    I. Occupational Health Equity /Low-Wage Workers as a “Priority Population”

    Connecting more concretely with the research agenda for the Occupational Health Equity Program seems crucial to me.

    The existence of low paying, precarious, temporary or unstable work arrangements creates a workforce at high risk of poor health (Leigh & de Vogli, 2015) due to the lack of a living wage, insecure work arrangements, potential for wage theft, poor health and safety conditions, lack of union representation and discrimination (Muntaner et al, 2010; Lipscomb et al., 2006). Health care workers at the lowest pay grades often have more in common with low-wage workers as a group than with health care workers as a group (Folbre, 2012; Poo, 2015), even in union settings.

    Minorities and those recently migrating to the United States are particularly vulnerable because they are more likely to find employment in low-wage, temporary jobs and more likely to experience discrimination on the job. All activity to advance a nuanced understanding of occupational health inequality should continue to be pursued – and should include both qualitative and quantitative approaches. Projects among health care workers and social assistance workers exposing and addressing discriminatory practices at the individual and structural levels should be prioritized.

    In my work with these groups, I have noticed that the urgent and troubling problems in this area are very difficult to address, but they also offer an interesting avenue of hope for improvement of relations between people of varying ethnicity as they serve the community at large.

    II. Explosion of Home Health Care Work (as the baby boomers require practical long-term care solutions).

    The job growth rate for home health care workers in New York State is 33% when projected until 2022. These trends are likely to lead to increased poverty and increased risk for work-related death, injury and illness. In fact, in 2013, the musculo-skeletal injury rate resulting in lost work days was 208.4 per 100,000 for nursing assistants. This is more than twice the rate of police officers and nearly four times that of a registered nurse (Bureau of Labor Statistics, 2013).

    Home health care workers serve the elderly by providing a wide variety of domestic, personal care and medical services, often filling an essential role in the daily lives of elderly persons. As with family caregivers or informal caregivers, the work of paid home health care workers is physically and emotionally exhausting (McCaughey et al., 2012, 2014; Markannen et al., 2014) and yet provides an opportunity to engage in highly meaningful work (Diamond, 1992; Stone, 2010). Home health care workers frequently work under precarious work arrangements for low wages and in poor work conditions (Stone, 2004; McCaughey, et al., 2012). Furthermore, the pathways to high quality training, appropriate pay scales, and a more respected role on the health care team for the workers are still impeded because home health care agencies must keep labor costs low.

    In spite of these difficulties, home health aides express a desire to avoid burnout, to be respected as they are doing valuable work in the community, and to pursue more pathways for professional development leading to increased wages (Stacey, 2011). But with demanding schedules and precarious work arrangements, like many other low-wage workers, care workers experience unstable and unpredictable work lives. They report a series of interconnected problems that must be taken into consideration without too much researcher disentanglement of these important factors: financial strain, wage theft, hazardous conditions at work in new and varied settings, difficulty accessing health care via workers’ compensation, and an overall lack of dignity on the job (Zoeckler et. al., 2014).

    In order to inform and sustain better social policy, a multidisciplinary approach incorporating the fields of demography, sociology, epidemiology, economics, health care services, labor studies, occupational health, and gerontology should collaborate for improved occupational health of home health care workers.

    III. Agency Level Factors (impacting both health care and social assistance workers)

    Working relationships between home health care delivery agencies (CHHAs/ LHCSAs) and other social service delivery agencies are sometimes complicated and tense. The connecting agencies have varying goals and staffing levels and are working in different systems of assistance delivery. The timer required to coordinate services is not recognized and allocated for in reimbursement schemes. This problem produces sources of job strain for both health care workers and social assistance workers. Further study of those agency level and individual worker level interactions could yield useful, policy oriented information in addition to reducing job strain for both health care workers and social assistance workers.

    Jeanette M. Zoeckler, MPH
    Occupational Health Clinical Centers, Syracuse NY

    Thank you so much for your thoughtful comment. The Healthcare and Social Assistance Sector has many low-wage workers with demanding and precarious work arrangements. The growing demand for home healthcare workers has not come with policies and infrastructure to make these jobs more predictable, well-paid and safer. We will consider your comments as well as the references you provided to assist in our planning.

    What areas of this industry sector should be focused on in the third decade of NORA?
    o Human (Social) Services

    What injuries and illnesses are of particular concern to workers in the health care and social assistance industry sector?

    o Assault inside workplace from clients and outside the workplace at residences of clients.

    What workplace interventions have been shown to be effective in this sector?
    o Partnering with LEO or Protective Services outside the workplace at client residences and pragmatic security and monitoring/training inside the workplace.

    What projects or initiatives do you think would have the greatest impact on workers in the health care and social assistance sector?
    o Begin with study the BLS Data and Industry Data to determine better ways to protect the H&S of those Human Services/Social Services personnel with daily contact with clients often in high-stress and emotional situations which can erupt into acts of violence. Work with staff to develop practical and effective methods of protection (both physical and mental).

    1. Within the health care industry there is still the vexing problem of exposure to antineoplastics for workers in oncology areas. While research has appropriately focused on nurses and pharmacists there is also a need to focus on other workers such as nursing assistants and janitorial staff who may have less understanding of the risks of exposure and the appropriate protective measures that should be taken. It is important to learn if health care institutions are following NIOSH guidelines and if not why not and how to improve use of PPE and other protective practices. It is also important to evaluate the impact of state regulations that have mandated policies on this issue.
    2. Within the health and social services industry workers providing personal cares to the elderly in assisted living and nursing homes are an important group to study as they are generally low wage workers whose work is demanding (physically and emotionally), and there is very high turnover in this arena . With the aging of the baby boomers this issue of who cares for the elderly is only going to get bigger and we need to pay attention to the well-being and safety of the care-givers.

    Thank you for your question and interest in protecting oncology healthcare workers. Evaluating workplace protections that are in place for the full range of healthcare workers (including nursing assistants and other assistive care staff, housekeeping and environmental services staff, etc) who are involved with patients receiving chemotherapy is an important research topic. NIOSH researchers are currently exploring options to study oncology these workers to better understand current precautionary practices relative to training, work practices, and use of PPE, and barriers to adhering to recommended safe handling guidelines for antineoplastic drugs. See the NIOSH topic page, Hazardous Drug Exposures in Health Care (http://www.cdc.gov/niosh/topics/hazdrug/). We will make note of your recommendation to evaluate the impact of state regulations addressing safe handling of hazardous drugs as we plan the 3rd Decade of NORA. With regard to your second comment, we recognize that there are many low-wage personal care assistants in assisted living and nursing homes who may need training or support for their health and safety. We will consider your recommendations for personal care assistants in our planning for the 3rd Decade of NORA. Thank you for your insights.

    Work place bullying remains to be an issue throughout different work environments.
    Work place safety and security for employees.
    Sexual harassment education in the work place environment
    Additional work place training for employees, including improved orientation during the first few weeks.
    Concerned about employee shortages in specified jobs.
    Air quality in work environment.

    *Note from NIOSH: References to products or services do not constitute an endorsement by NIOSH or the U.S. government.*

    The development and use of anesthetic agents is monumental in medicine and dentistry but these waste anesthetic gases (WAG) can escape from the delivery systems and/or be exhaled into the environment of the health care providers. One of these, Sevoflurane, is by far the most used agent and concerns about its safety with young children and elderly has increased. In addition, other pathogens from the lungs can be a respiratory health concern to the providers and thus exposure to these waste anesthetic gases and pathogens need to be minimized to the lowest level possible. Healthcare provider safety implies that scavenging all of these agents during and after the procedure should be done so that everyone has a safe outcome from both the surgical procedure and from delivering nursing care in this environment. Understanding this safety concern, the American Association of Peri-Anesthesia nurses adopted a position statement on air safety in 2002 and updated this position in 2016 to include air quality and occupational hazard exposure prevention.
    Over the last 15 years I have worked on the development of products to improve my work place environment and other health care providers. Working closely with James D. McGlothlin, Professor Emeritus from Purdue University and formerly with NIOSH, we have researched, published, and presented this work on visualization and capture of waste anesthetic gases. It started as a way to capture excess nitrous oxide in Dentistry with a product, Safe Sedate Mask, developed in conjunction with Ambu, formerly King Systems, in Noblesville IN. After developing ways to visualize these gases and seeing that patients exhale nitrous oxide, a new product, the Iso-Gard Mask, was developed with Teleflex Medical in Morrisville NC. The Iso-Gard mask system captures exhaled general anesthesia gases from the lungs of patients in the Post Anesthesia Care Unit (PACU). In the past, these gases would have accumulated in the PACU environment of the nurses and exposed them to possible health concerns, just like second hand smoke. Utilizing an infrared camera to visualize the Infra-red spectrum of these gases has allowed us to prove that these exposures exist and show that the Iso-Gard Mask reduced this respiratory exposure for health care providers. Since January of 2014 it has been used on patients in the Community Surgery Center North PACU and helped make the nursing environment safer. Seeing these agents has been a powerful motivational tool to use this system and to improve the health environment of health care workers.
    Patients may also exhale and cough up other pathogens such as blood, bacteria, and viruses that can be captured by the Iso-Gard mask. Recent lab research from Purdue found that the Iso-Gard mask can capture a significant amount of these pathogens and prevent them from entering the work place respiratory environment. This could lead to help reduce some of the possible medical errors, or hospital acquired infections, that the Center of Disease Control and Prevention (CDC) has estimated that have a direct cost up $33.8 billion dollars per year.
    Use of a cost/effective control, such as the Iso-Gard mask, has been shown to remove these waste anesthetic gases and other respiratory pathogens from the breathing zone of the health care provider and gets the exposure levels within the Government recommended guidelines established by NIOSH.
    I encourage NORA to conduct further research into how to reduce waste anesthetic gases, blood borne pathogens, and other respiratory pathogens. We have conducted research that proves these infective agents are in the breathing zone of health care providers from exhaled respirations of patients and would welcome the opportunity to present, share and show our research, and develop further studies to improve the respiratory quality of health care providers and reduce the risk of medical diseases in these providers.

    REFERENCES

    Centers for Disease Control and Prevention. Waste anesthetic gases—Occupational hazards in hospitals (2007), DHSS (NIOSH) Publication No. 2007-151. Available at: http://www.cdc.gov/niosh/docs/2007-151/. Accessed March 26, 2016.

    Wiesner G, Hoerauf K, Schroegendorfer K, Sobczynski P, Harth M, Ruediger HW. High-level, but not low-level, occupational exposure to inhaled anesthetics is associated with genotoxicity in the micronucleus assay. Anesth Analg. 2001;92(1):118-22.

    Sessler D, Badgwell J. Exposure of postoperative nurses to exhaled anesthetic gases. Anesth Analg. 1998;87:1083-1088.

    Krenzischek D, Schaefer J, Nolan M, Bukowski J, et al. Phase I collaborative pilot study: Waste anesthetic gas levels in the PACU. J PeriAnesth Nurs.2002;17(4):227–239.

    Cope KA, Merritt WT, Krenzischek DA, Schaefer J, et al. Phase II collaborative pilot study: preliminary analysis of central neural effects from exposure to volatile anesthetics in the PACU. J PeriAnesth Nurs. 2002;17(4):240-250.

    Crosby G, Culley DJ. Surgery and anesthesia: healing the body but harming the brain? Anesth Analg. 2011;112(5):999-1001.

    Food and Drug Administration, Science Board Advisory Committee. Significance of the Existing Nonclinical and Clinical Data and the Prioritization and Organization of Future Studies to Determine the Impact of the Anesthetic Agents on the Developing Brain. (2014). Available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/ScienceBoardtotheFoodandDrugAdministration/UCM422669.pdf. Accessed March 26, 2016.

    Badgwell JM. An evaluation of air safety source-control technology for the post anesthesia care unit. J PeriAnesth Nurs. 1996:11(4):207-22.

    Occupational Safety & Health Administration (OSHA). Anesthestic gases: guidelines for workplace exposures. 2000. Available at: https://www.osha.gov/dts/osta/anestheticgases/. Accessed March 29, 2016.

    Steege AL, Boiano JM, Sweeney MH. NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures. Am J Ind Med. 2014;57(6): 640–652.
    American Society of PeriAnesthesia Nurses. A Position Statement on Air Safety in the Perianesthesia Environment. 2002 Standards of Perianesthesia Nursing Practice. Cherry Hill, NJ: ASPAN; 2002.

    American Society of PeriAnesthesia Nurses. A Position Statement on Air Safety in the Perianesthesia Environment. 2002 Standards of Perianesthesia Nursing Practice. Cherry Hill, NJ: ASPAN; 2002.

    McGlothlin JD, Moenning JE. Waste anesthetic gases (WAGs) among employees in the healthcare industry. Clinical Foundations. (2013). Available at: http://www.clinicalfoundations.org/assets/cf_15.pdf. Accessed March 26, 2016.

    McGlothlin JD, Moenning JE, Cole SS. Evaluation and control of waste anesthetic gases in the postanesthesia care unit. J PeriAnesth Nurs. 2014;29(4 ):298-312.

    Personal Communications with Dr. James D. McGlothlin 2015.

    Thank you for your comments. NIOSH has evaluated control technologies during administration of anesthetic gases in medical and dental settings. We applaud efforts to control anesthetic waste gases and are interested in addressing knowledge gaps in this important area of research as it applies to medical and dental settings, but also to veterinary settings. We will consider your comments and the references you provided to assist in our planning.

    Some areas that would benefit from more research in the healthcare setting:

    1) Delivery of care in settings outside of traditional hospitals and medical offices is growing and will continue to grow (homes, small retail, mobile units). The assessment of exposures and available of suitable controls are not always on par with the more usual fixed sites. Deliver of medical care in the home is of particular concern and there is a need for improved interventions (equipment) for patient handling and mobilization since most of that technology is not suited to the home environment.
    2) Research and improved protocols for donning and doffing PPE to prevent cross or self-contamination.
    3) Ensuring we understand the barrier properties of PPE against biological hazards/infectious agents, including bio-aerosols.
    4) More specific recommendations re: techniques, design criteria, protocols to reduce risk of violence in various healthcare settings.
    5) Continued work to improve approached for slip/trip/fall prevention to include design criteria such as flooring materials (non-skid surfaces, cushioned, yet fully cleanable), sight lines, placement of utilities that affect cord management, etc.
    Thank you for the opportunity to comment.

    Thank you so much for your comment. You have pointed out a number of important areas for the Healthcare and Social Assistance Sector to consider. As you point out, the movement of healthcare out of hospitals and offices and into home settings brings increased challenges to worker safety. While NIOSH has done work in the areas of PPE evaluation, workplace violence and slip/trip/fall prevention there are aspects of these issues that have not been addressed. Thank you again for your thoughts and we will include them as we plan for the 3rd decade of NORA.

    What areas of this industry sector should we focus on in the third decade of NORA?
    – Aging workers, clinical students, those handling hazardous drugs (per USP800 roll out), sterile processing/central sterile, environmental services/housekeeping

    What injuries and illnesses are of particular concern to workers in the Healthcare and Social Assistance industry sector?
    – Infectious disease, HCV, multi drug resistant organisms (MRSA) colonization and/or infection, hazardous drug exposures, chemical exposures and heat/burns in sterile processing and EVS
    – NIOSH guidance on bloodborne pathogens is outdated and with the globalization of travel, this carries an unacceptable risk. With CDC announcing this year that HCV as the largest killer of any other infectious disease including TB and HIV, renewed focus on this topic area is needed to protect those working in healthcare and clinical labs. Also 1 in 8 people with HIV know they are infected, the creates great deal of unknown risk to those working in healthcare and social assistance. Additionally, there are potentially 3.5 million refugees with HBV infection that may access healthcare systems in US and around the world. NIOSH refocus on bloodborne pathogens can mirror the critically important role it played back in the 1990s.

    What workplace interventions have been shown to be effective in this sector?
    – APHA Policy Statement on Emerging Infectious Disease http://apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/07/15/40/preventing-occupational-and-community-transmission-of-ebola
    – roll out and ONS guidance on Hazardous Drugs (build on great work NIOSH has already done and update per new guidance)
    – Using data to build interventions/training for exposure to blood and body fluids https://americannursetoday.com/preventing-needlestick-sharps-injuries/ and https://americannursetoday.com/blood-body-fluid-splashes/

    What projects or initiatives do you think would have the greatest impact on workers in the Healthcare and Social Assistance sector?
    – Refocus (updates) on bloodborne pathogens and subsequent potential impact on emerging and re-emerging infectious disease
    – Putting experts on CDC HICPAC from NIOSH!
    – With an aging working population at NIOSH and retirements looming, recruitment of new and retention of current OSH experts at NIOSH will have a great impact.
    – Creative partnerships and projects with large health systems, hospital associations, insurers, workers comp carriers that create campaigns for worker protection. Could be similar to creating “worker safety and health bundles” just like healthcare does for patients. Florida Hospital Association: http://www.fha.org/education-and-events/event-details.aspx?itemId=637 and IHI http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx

    Excellent comments here. Anyways I have found a lack of guidelines for handling the new/old
    Virus,etc that have came to light for the first responders,sugery,ER, etc.
    There is a strong need for clear lines per area listed for an over all safety of the personal and public.
    There should be a clear penalty of failure to follow the set guides.

    1. What areas of this industry sector should we focus on in the third decade of NORA?

    Healthcare workers in the perioperative setting are exposed to multiple hazards such as surgical smoke, bloodborne pathogens, musculoskeletal injuries, waste anesthetic gases, methyl methacrylate, disinfectants, and glutaraldehyde. In addition to continuing focus on reducing sharps injuries and exposures to bloodborne pathogens for health care workers, AORN recommends that the Healthcare and Social Assistance Sector add a new focus on eliminating surgical smoke in our nation’s operating rooms.

    2. What injuries and illnesses are of particular concern to workers in the Healthcare and Social Assistance industry sector?

    Exposure to surgical smoke is a growing concern for health care workers in the perioperative setting. Perioperative nurses report twice the incidence of many respiratory problems as compared to the general population. The Occupational Safety and Health Administration (OSHA) estimated over 500,000 thousand healthcare workers are exposed to surgical smoke every year. Other reported health effects associated with surgical smoke exposure include acute and chronic inflammatory respiratory changes (eg, emphysema, asthma, chronic bronchitis);anemia; anxiety, carcinoma, cardiovascular dysfunction, dermatitis, eye irritation, headache, hepatitis, hypoxia, lacrimation, leukemia, nasopharyngeal lesions, nausea and vomiting; throat irritation; and weakness.

    3. What workplace interventions have been shown to be effective in this sector?

    The most effective means to prevent exposure to surgical smoke is the use of local exhaust ventilation whenever surgical smoke is generated with electrosurgical devices, lasers, ultrasonic devices, and powered instruments. Use of local exhaust ventilation with a smoke evacuator is higher in laser surgery cases compared to electrosurgery procedures. Despite its effectiveness, a 2010 survey of perioperative nurses by Edwards and Reiman indicated a usage rate of just 14% or less for local exhaust ventilation during electrosurgery procedures.

    4. What projects or initiatives do you think would have the greatest impact on workers in the Healthcare and Social Assistance sector?

    A focus on eliminating surgical smoke in our nation’s operating rooms would have a lasting impact on health care workers in the perioperative setting. Multiple studies have determined the contents of surgical smoke. Surgical smoke contains gaseous toxic compounds (eg, hydrogen cyanide, toluene, benzene), bio-aerosols, viruses, (eg, human papilloma virus [HPV], human immunodeficiency virus [HIV]), viable cancer cells, non-viable particles (ie, lung damaging dust of 0.5-5.0 ɥm) carbonized tissue, blood fragments and bacteria. The Hazard Evaluation and Technical Assistance Branch of the National Institute for Occupational Safety and Health (NIOSH) conducted field investigations of possible health hazards in the workplace associated with surgical smoke at the Laser Institute at the University of Utah Health Sciences Center in Salt Lake City, Utah,; Inova Fairfax Hospital in Falls Church, Virginia,; Morton Plant Hospital in Dunedin, Florida,; and Carolinas Medical Center in Charlotte, North Carolina. They tested the air for chemicals commonly found in surgical smoke and surveyed employees about heath symptoms associated with surgical smoke exposure. While the levels of formaldehyde, acetaldehyde, and toluene were below the relevant criteria for occupational exposure, of the employees surveyed the range of at least one symptom associated with surgical smoke exposure was 36%-52%.Thirty-three percent to forty-six percent of the employees described eye and upper respiratory irritation.

    Perioperative personnel are exposed to hazardous surgical smoke 8-12 hours a day, five days a week. Long-term studies of surgical smoke exposure and the effects of exposure to multiple volatile organic compounds (eg, benzene, toluene) are needed. Studies and evaluation have looked at a snapshot in time of their exposure but have yet to determine the consequences of long term exposure. Additionally, research is needed to update the ground breaking recommendations of HC-11 Control of Smoke from Laser/Electric Surgical Procedures.

    This input for the next decade of research for the NORA Healthcare and Social Assistance Sector is being provided by members of the American Nurses Association Sharps Injury Prevention Stakeholder Group – a group comprised of a broad range of expert stakeholders who meet quarterly and are engaged in ongoing activities relevant to the issue of sharps safety and injury prevention. The group includes clinicians, researchers, healthcare administrators, and representatives from professional associations and the medical device industry.

    Q1. What areas of this industry sector should we focus on in the third decade of NORA?
    Sharps injury surveillance and prevention needs to be placed back on the national occupational research agenda and OSHA’s priority list. With strong indicators of stalled progress in reduction of sharps injury rates over the past five years, national surveillance of sharps injuries in hospital and non-hospital settings becomes a critical step in order to identify and address underlying issues. Within non-hospital settings, lagging adoption of sharps with engineered sharps injury protections (SESIPs) in standing surgical centers and dentist offices are of particular concern.

    Q2. What injuries and illnesses are of particular concern to workers in the Healthcare and Social Assistance Industry sector?
    • Bloodborne pathogen exposure through preventable sharps injuries associated with use of various generations of SESIPs as well as conventional devices where use of (SESIPs) are deemed appropriate.
    • Increasing numbers of reported sharps injuries within ORs
    • Increasing risk related to infectious diseases that are expanding globally, including HCV and Zika for which SESIPs could potentially reduce transmission risk

    Q3. What workplace interventions have been shown to be effective in this sector?
    • Using data from the Sharps Injury Log in a manner that results in evaluation of SESIPs and promotion of workplace controls
    • Engagement of direct users in the evaluation and selection processes of SESIPs.
    • Conversion from devices lacking sharps injury prevention features to those with the most currently available technology to prevent or minimize exposure

    Q4. What projects or initiatives do you think would have the greatest impact on workers in the Healthcare and Social Assistance sector?
    • National injury surveillance and trending of employment setting injury data based on electronic submission of OSHA 300 logs to OSHA.
    • Federal grant funding for study of injury reporting, cost and psychosocial impact of worker injuries, and most effective strategies for sharps injury reduction.
    • Renewed collaboration among manufacturers, workplace safety advocates and professionals and government leaders

    Concerned about employee shortages in specified jobs.
    Workplace bullying remains to be an issue throughout different work environments.
    Workplace safety and security for employees.
    Additional workplace training for employees, including improved orientation during the first few weeks.
    Sexual harassment education in the workplace environment

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