The National Institute for Occupational Safety and Health is requesting public comment on the content and conduct of a survey of healthcare workers’ safety and health and a survey of healthcare employers’ safety and health practices. The goal of the healthcare worker survey is to collect information describing hazards, exposures, safety and health practices, and use of exposure controls by occupation and type and size of establishment. The goal of the management survey is to collect information describing facility-based health and safety resources, safety and health management programs, policies and practices for the same health and safety hazards covered in the worker survey, by type and size of establishment. Information collected from these hazard surveillance surveys will be useful in identifying gaps relative to the use of best practices and define future research and intervention priorities.
Background
Preliminary work on this effort included a feasibility study which was completed in 2006. The study assessed the feasibility of collecting self-reported information on health and safety practices from healthcare workers at their workplace. Worker and management questionnaires were developed (based on healthcare stakeholder input) and refined using focus groups/cognitive interviews, and pilot-tested at two large medical centers. Based on the pilot test findings, it was decided that it would be more cost-effective to implement the worker survey as a web-based survey through various professional and labor organizations. The management questionnaire will be targeted to individuals responsible for facility health and safety, based on a representative sample of healthcare establishments. Although the content of the questionnaires has been fairly well-defined, we are seeking information from meeting participants on other important or emerging healthcare safety and health issues for possible inclusion in the questionnaires, as well as other information. The surveys address broad health and safety issues such as work organization (e.g., work hours) worker survey, violence, physical demands (e.g., patient lifting), needlestick injuries, and use of personal protective equipment (PPE/C). Specific emphasis is placed on charactering exposure determinants for antineoplastic agents, selected aerosolized medications, chemical sterilants, high level disinfectants, anesthetic gases, surgical smoke, and cleaning and sanitization agents.
The objective of this project is to describe the prevalence and distribution of important health and safety hazards and perceptions, work practices, and use of exposure controls from a worker perspective, and to describe institution-based health and safety management policies, programs and resources. The objective of this project will be achieved through five specific aims:
- Conduct web-based worker survey aimed at members of participating professional and labor groups who have potential exposure to targeted chemical agents;
- Conduct web-based management survey aimed at health and safety manager (or person primarily responsible for employee occupational health) at healthcare establishments;
- Describe prevalence and distribution of worker exposures, health and safety perceptions and practices, and use of exposure controls and barriers to their use;
- Describe prevalence and distribution of facility–based health and safety management policies, programs, and resources; and
- Share results with participating organizations, healthcare stakeholders, the general public and the scientific community.
The proposed worker questionnaire outline and questionnaire are provided below:
Core Module
- Health and safety perceptions
- Work organization (work hours, changing shifts)
- Job stress
- Use of safe needle devices/needlesticks
- Workplace violence
- Physical demands (lifting, repetitive tasks)
- General use of personal protective equipment/clothing
- Medical surveillance
- Demographics
Hazard Modules*
- Aerosolized medications
- Antineoplastic agents (prepare)
- Antineoplastic agents (administer)
- Chemical sterilants
- High level disinfectants
- Surgical smoke
- Anesthetic gases (administer)
- Anesthetic gases (bystander)
- Anesthetic gases (surgical recovery)
- Cleaning agents
*Each hazard module addresses health and safety training, exposure determinants (i.e., frequency, duration and amount used), work practices, use of engineering controls and PPE/C.
This table presents targeted occupations and specific health and safety hazards for each module in the worker questionnaire.
Module |
Targeted Hazard |
Specific Agents |
Targeted Occupation(s) |
Core |
Cross-cutting health and safety hazards |
Physical job demands, work organization, sharps, stress, violence |
All respondents |
A |
Aerosolized Medications |
Ribavirin, pentamidine, tobramycin |
Respiratory therapists, pediatric nurses |
B |
Preparing Antineoplastic Agents |
Pick list of commonly used chemo drugs |
Pharmacists and pharmacy technicians |
C |
Administering Antineoplastic Agents |
Same as above |
Oncology nurses and infusion nurses |
D |
Chemical Sterilants |
Ethylene oxide, hydrogen peroxide gas plasma |
Medical supply technicians |
E |
High Level Disinfectants |
Glutaraldehyde, orthophthaldehyde, peracetic acid, hydrogen peroxide |
Medical supply technicians and endoscopy technicians |
F |
Surgical Smoke |
Surgical smoke |
Surgeons, anesthesiologists, nurse anesthetists, operating room nurses, dermatologists, medical assistants who use lasers or electrosurgery devices. |
G |
Waste Anesthetic Gases, admiinister |
Desflurane, enflurane, halothane
isoflurane, nitrous oxide, sevoflurane |
Surgeons, anesthesiologists, nurse anesthetists |
H |
Waste Anesthetic Gases, bystander |
Same as above |
Medical and surgical assistants and perioperative nurses |
I |
Waste Anesthetic Gases, Post-Anesthesia Care Unit (PACU) |
Same as above |
Perioperative nurses |
J |
Housekeeping Hazards (selected cleaning agents and hazardous spill cleanup) |
Quaternary ammonium compounds, phenols, aldehydes, oxidizers, etc |
Housekeeping/janitorial/environmental services personnel |
The proposed management questionnaire* outline and questionnaire are provided below:
Main Section
- Facility demographics
- Health & Safety resources
- Health & Safety program elements
- Workplace stress management
- Ergonomics program
- Workplace violence prevention
- Latex management/training
- Required respiratory protection/training/fit testing
- Emergency preparedness (scope, resources, training, surveillance)
- Facility demographics
Hazard Sections**
- Specific agents used
- Number/gender of workers using agents
- Training
- Exposure monitoring/medical surveillance
- Work practices and engineering controls
- Required respiratory protection
*To be completed by person with primary responsibility for worker health and safety at sampled establishment
**addresses each of the seven targeted hazards covered in the worker questionnaire
Proposed Management Questionnaire |
Management Qx_0308.pdf
(152KB; 7 pgs) |
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Input Sought from Stakeholders
- Content of surveys
- Conduct of surveys
- For professional associations or labor organizations who represent healthcare workers, the willingness of your organization to partner with NIOSH and facilitate a survey of your members
Other comments on the surveys
Public Comment Period
Comments will be accepted until 5:00 p.m. ET on July 1, 2008
To submit comments regarding this draft publication, please use
one of these options:
- Send NIOSH comments using this online
form
- Send comments by email.
- Fax comments to the NIOSH Docket Office: 513-533-8285
- Send by Mail to:
NIOSH Mailstop: C-34
Robert A. Taft Lab.
4676 Columbia Parkway
Cincinnati, Ohio 45226
NIOSH Draft Documents for Public Review
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