|
|
|
|
|
|
|
NIOSH Programs > Health Care and Social Assistance > NIOSH Funded Research Grants
Health Care and Social AssistanceActivites: NIOSH Funded Research GrantsNIOSH sponsors research and training through its extramural programs, which complement the Institute's intramural programs. More information is available form the NIOSH Office of Extramural Programs. Risk Factors and Incidence of Sharps Injuries to NursesNurses are the largest group of U.S. healthcare workers who experience percutaneous injuries with used sharps. Despite the increasing use of safety-engineered sharps, spurred in large part by federal legislative activity during the 1990s, uptake of safer equipment and best practices remains inconsistent (especially outside hospitals) and injury incidence rates remain high. Early evidence suggests that organizational factors such as staffing levels and workplace climate play a role in needle sticks that is similar to their connection to safety problems impacting patients. Sharps injuries outside hospital settings are much less well-documented and their correlates are poorly understood. This study will use survey data collected in 2005-2006 from nearly 65,000 nurses working in 600 hospitals, as well as home health care agencies and nursing homes in three states (New Jersey, Pennsylvania, and California) to investigate sharps injury incidence and risk factors. Aims include evaluating incidence of injuries in hospitals across major specialties, as well as individual and organizational correlates of injury, including hospital-level workloads and work environment characteristics. A comparison of incidence rates and risk factors between hospital nurses and nurses in home health and nursing homes will also be carried out. Further study of sharps injuries in the era following landmark federal sharps safety legislation passed in 2000 is needed. Results from this study, which would be the largest of its type ever conducted, would have great importance for researchers and practitioners in occupational health, as well as leaders and policy makers concerned with health care safety. The public health impact relates to better strategies for control of exposure to blood borne pathogens in healthcare workers as well as improving workplace safety more generally. Project contact: Sean Clark NIOSH Contact: Linda Frederick Experimental and Theoretical Study of Early Detection and Isolation InfluenzaInfluenza is a highly transmissible respiratory virus that causes an average of 114,000 hospitalizations and 36,000 deaths in the United States each year. It is of particular concern today because of the potential for an avian influenza pandemic. Transmission of influenza among patients and employees in healthcare settings is still common because immunization rates among healthcare workers are low, and employees often continue to work with respiratory illnesses. During outbreaks in nursing homes, illness rates greater than 60% have been reported. A better understanding of the role of various modes of transmission of influenza virus is needed to better plan and allocates resources during the recurring annual influenza outbreaks and to prepare for a possible pandemic. The objective of our study is to characterize the size and quantity of aerosol droplets produced by humans while coughing, and then uses this information to better understand the mechanisms by which influenza is transmitted from infected individuals to others. This objective will be accomplished using well-established experimental and theoretical techniques in conjunction with laboratory experiments and actual clinical studies. The specific aims are: (I) Characterize aerosol production by coughing. A measurement system will be used to characterize cough-generated aerosols from human subjects and the ability of surgical masks and N95 respirators to block the dissemination of cough generated aerosols will be evaluated. (II) Study the dissemination of virus-laden aerosols produced by coughing. A commercial live attenuated influenza vaccine will be used as a surrogate to study airborne viral transmission in the laboratory. Laboratory experiments will also be used to validate and improve a prototype two-stage bio aerosol sampler and PCR-based virus detection system. The sampler will then be used to study the spread of influenza in a healthcare facility, where selected workers will be monitored during the months of high influenza activity. (III) Develop a computer model of the aerosol generation and dispersion. Computer models based on physical principles will be developed and utilized to complement the experimental work. A hierarchy of models ranging from one-dimensional steady to three dimensional transient simulations will be utilized and validated against experimental results. Project contact: Ismail Celik NIOSH Contact: Joan F Karr, PhD Testing Interventions to Human-Generated Occupational Airborne InfectionsMost currently recommended interventions to control airborne infection have never been rigorously tested against human-generated infectious aerosols, in part because of an inability to quantitatively air sample for most airborne pathogens under real life conditions. We plan to study patients with infectious multi-drug resistant tuberculosis (MDR-TB) as a prototype airborne infection in a unique Airborne Infections Research (AIR) facility in South Africa designed to efficiently test the efficacy of infection control interventions through the use of quantitative guinea pig air sampling. Guinea pigs in one of two identical chambers are exposed on alternate days to the exhaust air from 3 2-bed rooms and the common area of the AIR patient suite. The infection control intervention is applied in the patient rooms on alternate days. Guinea pig exposure Chamber A receive air from the patient rooms only when the intervention is operative, while exposure Chamber B receives air from the patient rooms only under control conditions. The difference in the infection rate of guinea pigs in the two chambers, as determined by tuberculin skin testing, is a measure of the efficacy of the intervention. The HYPOTHESES to be tested are that two rapid response interventions (face masks on infectious persons and portable room air cleaning machines), and two pre-planned preventive interventions (upper room and in-duct UV air disinfection) can effectively reduce the risk of person to person airborne transmission. Project Contact: Edward Nardell NIOSH Contact : Joan F Karr, PhD Violence against Home Health and Hospice WorkersHealth care workers frequently face the threat of violence at work, and this violence can lead to fear, stress, physical injury, and even death. Nearly one-third of all nonfatal occupational injuries due to assaults and violent acts occur in the health care sector. The incidence of violence among home health care workers is largely unknown but likely exceeds that of health care providers working in health care facilities. Home health care workers experience many of the same violent hazards as health care workers in hospitals, which are primarily associated with the provision of medical care to patients who are aggressive, disoriented, or under the influence of illegal substances. However, home health workers face additional risks because they provide this care in an uncontrolled setting. Threats can come from crime-ridden neighborhoods, hazards within the patient's home, and from the patient and other household occupants. Strategies to protect home health workers are suggested in the literature, although few strategies are supported by evidence of their effectiveness in reducing violence. In addition, the Occupational Safety and Health Administration released "Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers". However, there are no studies that evaluate these strategies from the organization of work perspective. The long range goal of this research is to increase the implementation of comprehensive security programs into home health agencies to reduce violent events and their consequences on home health workers. The objectives are to understand the interaction of organizational, worker and job characteristics and the external environment that contribute to and protect home health workers from violence, and to identify the most effective strategies to intervene. The specific aims are to: (1) Examine the incidence and contexts of workplace violence on home health care workers; (2) Identify risk and protective factors for violence based on characteristics of the organization (e.g., agency violence prevention policies, infrastructure), worker (e.g., safety climate) and job (e.g., patient and household exposures) context, and external environment (e.g., social contextual factors); (3) Identify which of the Cal/OSHA-recommended elements are present within each participating branch agency; (4) Identify the effectiveness of organization-level policies and worker implementation of these policies on the incidence of violence; (5) examine the relationship between perceived safety climate and home health worker compliance to organizational-level workplace violence prevention policies. We will assess agency-level policies and prevention efforts among five home health agencies in Northern California, who employ over 2,000 workers. This research will provide the first estimates of the effectiveness of home health violence prevention approaches using a prospective research design and incorporating all constructs of the organization of work framework. Project Contact: Carrie Casteel NIOSH Contact : Bernie Kuchinski, PhD Sleep Loss, Sleepiness and Fatigue in 12-Hour Nurses Sustained work day (shifts lasting 12 hours or more) have become common in nursing, especially in combination with compressed schedules (e.g. three 12-hour days in succession). This work schedule limits the opportunity for sleep, and can lead to fatigue-related accidents, injuries, and long-term adverse health effects. Because neurocognitive performance changes are an early indicator of fatigue, they are useful for exploring the impact of sustained workdays on nurses. The proposed study will examine sleep, sleepiness, fatigue, and neurocognitive performance over three successive sustained workdays among critical care nurses working in hospitals. The aims of the study are to: (1) describe the number of hours of sleep that nurses actually achieve over successive sustained workdays, (2) measure sleepiness, fatigue, and changes in neurocognitive performance over these workdays, (3) describe the relationship between achieved sleep and fatigue, sleepiness and neurocognition and (4) Assess the congruence of 'high risk for sleep apnea' as scored with the Berlin Questionnaire, with a polysomnogram-confirmatory diagnosis of OSA in a small sample of registered nurses working successive 12-hour shifts. Project Contact: Jeanne Geiger-Brown NIOSH Contact : Bernie Kuchinski, PhD
Page last updated: July 30, 2008
Page last reviewed: October 20, 2008 Content Source: National Institute for Occupational Safety and Health (NIOSH) Division of Respiratory Disease Studies |
|
NIOSH Program:Health Care and Social Assistance |
|||||
