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:

1. Conduct web-based worker survey aimed at members of participating professional and labor groups who have potential exposure to targeted chemical agents;
   
   
2. Conduct web-based management survey aimed at health and safety manager (or person primarily responsible for employee occupational health) at healthcare establishments;
   
   
3. Describe prevalence and distribution of worker exposures, health and safety perceptions and practices, and use of exposure controls and barriers to their use;
   
   
4. Describe prevalence and distribution of facility–based health and safety management policies, programs, and resources; and
   
   
5. 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*

1. Aerosolized medications
2. Antineoplastic agents (prepare)
3. Antineoplastic agents (administer)
4. Chemical sterilants
5. High level disinfectants
6. Surgical smoke
7. Anesthetic gases (administer)
8. Anesthetic gases (bystander)
9. Anesthetic gases (surgical recovery)
10. 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.

CORE MODULE	Worker Qx_Core Module_0308.pdf (456KB; 25 pgs)
MODULE A: Aerosolized Medications (Respiratory Therapists)	Worker Qx_Module A_Aerosolized Medications_0308.pdf (170KB; 11 pgs)
MODULE B: Antineoplastic Agents (Pharmacists, Pharmacy Technicians)	Worker Qx_Module B_Antineoplastic Agents_Prepare_0308.pdf (168KB; 10 pgs)
MODULE C: Antineoplastic Agents (Oncology Nurses)	Worker Qx_Module C_Antineoplastic Agents_Administer_0308.pdf (134KB; 8 pgs)
MODULE D: Chemical Sterilants	Worker Qx_Module D_Chemical Sterilants_0308.pdf (134KB; 8 pgs)
MODULE E: High Level Disinfectants	Worker Qx_Module E_High Level Disinfectants_0308.pdf (133KB; 8 pgs)
MODULE F: Surgical Smoke (from Lasers or Electrosurgery Devices)	Worker Qx_Module F_Surgical Smoke_0308.pdf (106KB; 8 pgs)
MODULE G: Anesthetic Gases (Administration)	Worker Qx_Module G_Anesthetic Gases_Administer_0308.pdf (109KB; 6 pgs)
MODULE H: Anesthetic Gases (Bystanders who do NOT Administer)	Worker Qx_Module H_Anesthetic Gases_Bystander_0308 - for mer.pdf (456KB; 5 pgs)
MODULE I: Waste Anesthetic Gases (Post Anesthesia Care and Surgical Recovery)	Worker Qx_Module I_Anesthetic Gases_Recovery_0308.pdf (69KB; 3 pgs)
MODULE J: Housekeeping or Environmental Services Staff	Worker Qx_Module J_Housekeeping_0308.pdf (456KB; 25 pgs)
The free Adobe Acrobat Reader is needed to view these files.

This table presents targeted occupations and specific health and safety hazards for each module in the worker questionnaire.

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)
The free Adobe Acrobat Reader is needed to view these files.

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

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