Health Care and Social Assistance
Outputs: Publications
Selected Publications
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Asthma
Work-Related Asthma Among Health Care Workers: Surveillance Data from California , Massachusetts , Michigan , and New Jersey, 1993-1997
Am J Ind Med 2005 Mar; 47(3):265-275
As a part of four state-based surveillance systems, physician reports and hospital discharge data were used to identify cases of work-related asthma and interviews were conducted to identify associated occupations and exposures. Healthcare workers accounted for 16% of 1,879 confirmed cases, and were primarily employed in hospitals as nurses. Most commonly reported exposures included cleaning products, latex and poor air quality.
Chemical Hazards
Waste Anesthetic Gases - Occupational Hazards in Hospitals
DHHS (NIOSH) Publication 2007-151 (September 2007)
The purpose of this brochure is to increase awareness about the adverse health effects of waste anesthetic gases; describe how workers are exposed to waste anesthetic gases; recommend work practices to reduce these exposures; and identify methods to minimize leakage of anesthetic gases into the work environment.
Surface Contamination of Chemotherapy Drug Vials and Evaluation of New Vial-Cleaning Techniques: Results of Three Studies
Am . J. Health-System Pharm 2005 62 (5), 475-484.
Results of three studies demonstrated levels of surface contamination of vials with chemotherapeutic agents well above the limit of detection. Improved decontamination procedures, combined with the use of protective sleeves during the manufacturing process reduced contamination levels by 90%.
NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings
DHHS (NIOSH) Publication No. 2004-165 (2004)
Provides health care workers and employers with measures for minimizing exposure to hazardous drugs.
Cleaning Products and Work-Related Asthma
J Occup Environ Med 2003 May; 45(5):556-563
Data from four state-based surveillance systems (CA, MA, MI and NJ) identified 236 (12%) of 1915 cases of work related asthma being associated with exposure to cleaning products. Most likely exposures were in medical settings and involved nurse/nurses aides and janitors/cleaners. The authors recommended that additional research is needed to characterize specific agents and circumstances of use.
Current Intelligence Bulletin 34: Formaldehyde: Evidence of Carcinogenicity
DHHS (NIOSH) Publication No. 81-111 (1981, updated 1997)
Presents information about formaldehyde as well as recommendation to treat formaldehyde as a carcinogen.
Glutaraldehyde: Occupational Hazards in Hospitals
DHHS (NIOSH) Publication No. 2001-115 (May 2001)
Describes the adverse effects of exposure to glutaraldehyde, occupational exposures, and control.
En Español
Child Day Care
Occupational Health and Safety Issues in Child-Care Work
Pediatrics 1994 Dec;94(6):1079-1080
This paper describes health and safety issues in child day care settings, including communicable diseases, occupational stress, and ergonomic hazards.
Varicella-Zoster Virus Susceptibility in Day-Care Workers
Appl Occup Env Hyg 1992 Mar;7(3):191-194
The purpose of this study was to determine the proportion of day care workers susceptible to Varicella-zoster virus (VZV) in child day care centers and to compare these data to susceptibility rates in other adult populations, mainly hospital personnel.
Dental Offices
A Long-Term Study of the Development of N20 Controls at a Pediatric Dental Facility
Am Ind Hyg Assoc J 2000 Sep-Oct; 61(5):753-756
This study reviews
NIOSH efforts to control nitrous oxide (N20) levels at a pediatric dental operatory from 1978 to 2000. Measurements of N20 concentrations were made before and after installation of different controls. Overall, of N2O concentrations were reduced by a factor of 61 from initial levels and achieving the NIOSH recommended exposure limit appears to be achievable.
Ergonomics and Dentistry: A Literature Review
Ergonomics and the Dental Care Worker. Washington , DC : American Public Health Association, 1998 Jun; :25-81
This chapter provides a brief summary of selected literature on ergonomics and dentistry, and is organized into three main sections: musculoskeletal disorders and risk factors, psychosocial disorders and risk factors, and availability and effectiveness of current ergonomic interventions.
Hazard Control 3 - Control of Nitrous Oxide in Dental Operatories
DHHS (NIOSH) Publication No. 96-107 (1998)
Contains suggestions on controlling exposure to nitrous oxide.
Nitrous Oxide Control in the Dental Operatory: Auxiliary Exhaust and Mask Leakage, Design, and Scavenging Flow Rate as Factors
Am Ind Hyg Assoc J 1996 Mar; 57(3):272-278
This study evaluated the effectiveness of local exhaust ventilation and an improved patient mask in minimizing nitrous oxide (N20) concentrations in a pediatric dental operatory. The authors concluded that a commonly used mask does not reliably control N20 emissions, even with scavenging. The use of a redesigned mask with a flexible slitted skirt on the outer shell effectively captured gas leaking from the inner shell of the mask.
Economics
Costs of Occupational Injury and Illness within the Health Services Sector
Int J Health Serv 2005 Apr-Jun; 35(2):343-359
This paper analyzed data from BLS and other sources to estimate and compare costs across occupations, and types of injuries and illnesses within the health services sector. The hospital industry was the third most expensive of 313 U.S. industries; injuries and illnesses comprised
roughly 90% and 10%, respectively, of total costs.
Engineering Controls
Ethylene Oxide Sterilizers in Health Care Facilities - Engineering Controls and Work Practices
Describes sources of (EtO) for gas sterilization and recommended controls.
Control of Smoke From Laser/Electric Surgical Procedures (Hazard Control)
DHHS (NIOSH) Publication No. 96-128 (March 1998)
Describes how to control airborne contaminants generated by lasers and electrosurgical devices.
Health Care Workers at Correctional Facilities
Read, Wear and Report poster
DHHS (NIOSH) Publication No. 2007-156
Bloodborne Pathogen Exposure poster
DHHS (NIOSH) Publication No. 2007-157
These posters are meant to reinforce how frontline health care workers can protect themselves from exposures to bloodborne diseases.
Protect Your Employees with an Exposure Control Plan brochure
DHHS (NIOSH) Publication No. 2007-158
Provides information to medical service administrators and supervisors about improving facility Exposure Control Plans.
Encourage Your Workers to Report Bloodborne Pathogen Exposures brochure
DHHS (NIOSH) Publication No. 2007-159
Provides information for encouraging the reporting of worker bloodborne pathogen exposure in correctional facilities.
Infectious Agents
Cluster of Severe Acute Respiratory Syndrome Cases among Protected Health Care Workers - Toronto , Canada , April 2003
MMWR 2003 May; 52(19):433-436
This report summarizes a cluster of severe acute respiratory syndrome (SARS) among healthcare workers in a hospital where infection-control precautions either had not been instituted or had been instituted but not followed.
Latex Allergy
Latex Allergy: Past and Present
Int Immunopharmacol 2002 Feb; 2(2-3):225-238
This manuscript provides a brief history of latex allergy, and a review of the following: manufacturing process for dipped latex products, the 11 latex allergens that have been characterized and received allergen designations by the International Union of Immunological Societies, and the methods used in exposure assessment, the epidemiology and clinical management of latex allergy, and the use of animal models in investigating mechanisms underlying latex allergy.
Clinical and Occupational Outcomes in Health Care Workers with Natural Rubber Latex Allergy
Ann Allergy, Asthma, & Immun 2003 Feb; 90(2):209-213
The purpose of this study was to retrospectively evaluate (via questionnaire) health and economic outcomes in 67 Health Care Workers identified with natural rubber latex (NRL) allergy and percutaneous reactivity to NRL. Symptoms included urticaria in 67 (100%), rhinitis in 23, asthma in 25 and anaphylaxis in 4 workers. Clinical symptoms in this group of HCWs were favorable after institution of interventions (non-NRL gloves or workplaces), but incurred deleterious consequences in a minority of workers.
Latex Allergy: A Prevention Guide
DHHS (NIOSH) Publication No. 98-113
Preventing Allergic Reactions to Natural Rubber Latex in the Workplace
DHHS (NIOSH) Publication No. 97-135
En Español
Detailed description of latex allergy including presentation of existing data and description of six case reports of workers who developed latex allergy. The document also presents NIOSH recommendations for minimizing latex-related health problems in workers while protecting them from infectious materials.
Musculoskeletal Disorders and Interventions
Compilation of Research on Back Injuries Among Nursing Personnel
Proceedings of the West Virginia Nurses' Association Research Symposium, Nursing: power through Excellence, Wheeling , West Virginia , October 22-23, 1988 :10 pages
Seventy-four studies published between 1967 and 1987 that presented new data or a synthesis of a select group of studies that concerned back pain among nursing personnel were reviewed and categorized according to type of investigation, measurement methodology, findings about selected risk factors, and findings about prevention or risk reduction programs.
Musculoskeletal problems of the Neck, Shoulder, and Back and Functional Consequences in Nurses
Am J Ind Med 2002 Mar; 41(3):170-178
This study involved the analysis of neck, shoulder and back problems from 1,163 working nurses. The authors found that 46%, 35% and 47% of nurses had neck, shoulder or back pain within the past year and suggest opportunities for intervention.
Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back
DHHS (NIOSH) Publication No. 97-141 (1997)
A comprehensive compilation and review of epidemiologic research on the relationship between work-related MSDs of the neck, upper extremity, and low back and exposure to physical factors at work. It includes a bibliography and tables summarizing the literature.
Reduction in Injury Rates in Nursing Personnel through Introduction of Mechanical Lifts in the Workplace
Am J Ind Med 2003 Nov; 44(5):451-457
This study evaluated injury and lost work day rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities. The post-intervention period showed decreased rates of musculoskeletal injuries, lost workday injuries and total lost work days due to injury, with larger reductions being observed in LTC facilities than in hospitals. This study showed that patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings.
An Evaluation of a "Best Practices" Musculoskeletal Injury Prevention Program in Nursing Homes
Inj Prev 2004 Oct; 10(4):206-211
The objective of this study was to conduct an intervention trial of a "best practices" musculoskeletal injury prevention program designed to safely lift physically-dependent nursing home residents. A pre-post intervention trial and cost-benefit analysis at six nursing homes over a 6-year period was designed and involved a cohort of 1,728 nursing staff. The "best practices" program consisted of mechanical lifts and repositioning aids, a zero-lift policy, and employee training on lift usage. The results showed a significant reduction in resident handling injury incidence, WC costs, and lost workday injuries after the intervention.
Needlesticks
Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel
DHHS (NIOSH) Publication No. 2007-132 (April 2007)
This document was developed by the Occupational Safety and Health Administration (OSHA), Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services.
NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings
DHHS (NIOSH) Publication No. 2000-108
This booklet describes the risk of needlestick injury and prevention strategies.
En Espanol
Prevalence of Safer Needle Devices and Factors Associated With Their Adoption: Results of a National Hospital Survey
APHA 130 th Annual Meeting and Exposition, November 9-13, 2002, Philadelphia , PA , 2002
This study presents the results of a telephone survey of a random sample of 494 hospitals regarding the extent of adoption of safer needle devices. Although use of safer needle devices is the mandated and preferred way to protect workers from needlesticks, complete adoption of this technology will primarily depend upon support of the social systems in which it is used and the people who use it.
Blood and Body Fluid Exposure Risks Among Health Care Workers: Results from the Duke Health and Safety Surveillance System
Am J Ind Med 2004 Dec; 46(6):637-648
The objective of this research was to better define the blood and body fluid (BBF) exposure risk and risk factors among a population of 24,425 employees of a large tertiary medical center, utilizing a new comprehensive occupational health surveillance system. The study population reported 2,730 BBF exposures during the study period (1998 to 2002), resulting in an overall annual rate of 5.55 evants/100 FTEs and a rate of 3.0 for percutaneous exposures. Rates of percutaneous exposures from hollow needles were found to decrease while rates from suture needles appear to be increasing. The need for continued employee training, better safety devices /products and work practices was recommended.
Innovative Bloodborne Pathogen Training for Registered Nurses
NIOSH 2004 Dec; 1-25
This research involved the development and evaluation of an innovative approach to BBP safety training for registered nurses. A computer-based training format employing simulated exercises was developed; this model has successfully been used in other occupational settings to improve knowledge and reinforce safety related behaviors. Mechanisms employed to evaluate the training program were presented and may have important implications for effective health and safety training of nurses.
Workers' Compensation Claims for Needlestick Injuries among Healthcare Workers in Washington State, 1996-2000
Infect Control Hosp Epidemiol 2005 Sep; 26(9):775-781
The purpose of this study was to characterize workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital and hospital settings in Washington state. The incidence of needlestick injury claims was highest in hospitals, followed by dental offices, physician offices and in skilled nursing facilities. The most common mechanisms of needlestick injury by work location were: suturing (hospitals); recapping (dentists' offices); needle disposal (physician offices, skilled nursing facilities). There was a difference in the incidence rate and mechanisms of needlestick injuries for HCWs in non-hospital and hospital settings.
Selecting, Evaluating, and Using Sharps Disposal Containers
DHHS (NIOSH) Publication No. 97-111, January 1998
This document presents a comprehensive framework for selecting sharps disposal containers and evaluating their efficacy as part of an overall needlestick injury prevention plan.
Worker Health Chartbook 2004: Bloodborne Infections and Percutaneous Exposures
DHHS (NIOSH) Publication No. 2004-146
Provides data from the CDC about two of the major occupational bloodborne infections-hepatitis B and HIV, the virus that causes AIDS.
Organization of Work
The Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units
N Engl J Med 2005 Jan; 351(18):1838-1848 This study compared the rates of serious medical errors made by interns while working according to traditional schedule with extended work shifts and while working an intervention schedule that eliminated extended work shifts. The interns made 36% more serious errors during the extended work schedules than during the intervention schedule. Recommendations were made relative to eliminating extended work shifts and reducing the number of hours interns work per week.
Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries and Health Behaviors
DHHS (NIOSH) Publication No. 2004-143
Presents a review of the methods and findings from 52 studies that examined the relationship between long work hours and selected health outcomes. Also provides recommendations on issues and priorities to consider in future research.
Shift Work and Risk of Spontaneous Abortion in Nurses
Am J Epidemiol 2005 Jun; 16 1(11)(Suppl):S127
Evidence suggests that work schedule, including rotating work and night work, may have an adverse effect on reproductive outcome, but results from these studies are ambiguous, and there are few studies of U.S. health care workers. NIOSH examined this question among 7,688 female participants of the Nurses' Health Study II, a prospective U.S. cohort established in 1989. Preliminary results suggest that women who work nights during their first trimester have an increased risk of miscarriage compared to women who work days.
Personal Protective Equipment and Clothing
Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents
DHHS (NIOSH) Publication No. 2002-109 (2001)
Contains recommendations for personal protective equipment use in given exposure conditions based on current understanding at the time of publication.
TB Respiratory Protection Program In Health Care Facilities: Administrator's Guide
Contains information specific to tuberculosis but also provides useful information on respirators, including types used to protect healthcare workers who may be exposed to SARS. Includes section on user seal check and fit-testing.
Reporting Work-Related Injuries
Nurses' Inclination to Report Work-Related Injuries: Organizational, Work-group, and Individual Factors Associated with Reporting
AAOHN J 2005 May; 53(5):213-217
This study examined several factors and nurses' inclination to report work-related injury. Reporting was higher in organizations with onsite health programs, and when health and safety committees included front-line nurses and occupational health representatives. Reporting was reduced when nurses felt lack of concern for staff welfare from supervisors and a climate of blame for worker injuries was present. Improvements in reporting climate would be expected to increase the value of injury data for identifying workplace hazards.
Slips, Trips, Falls
A Case-Crossover Pilot Study of Slips, Trips, and Falls in Health Care Workers
NOIRS 2003-Abstracts of the National Occupational Injury Research Symposium 2003. Pittsburgh , PA : NIOSH, 2003 Oct; :75
The purpose of this study was to describe the circumstances of slips, trips and falls (STFs) in the hospital environment and to evaluate the role of potential transient risk factors in their occurrence. Preliminary analysis suggests that walking on a different pathway than usual, on contaminated floors (most often water or cleaning solutions), and being distracted or rushing may increase the risk of a STF in a hospital setting.
Tuberculosis (TB)
Tuberculosis in Health Care Workers
APHA 130th Annual Meeting and Exposition, November 9-13, 2002, Philadelphia, PA , 2002 Nov :1
This paper summarizes the most recent scientific literature and statistics for the incidence rate of TB infection and active TB in healthcare workers. Ongoing improvements in surveillance programs and prevention effectiveness research on TB were recommended to guide future interventions to protect healthcare workers.
Health Hazard Evaluations (HHEs): Tuberculosis (1990-1999)
DHHS NIOSH Publication No. 2001-116 (2001)
Titles and summaries of Health Hazard Evaluations conducted from 1990 through 1999 related to Tuberculosis, organized by type of facility.
Efficacy of Utlraviolet Irradiation in Controlling the Spread of Tuberculosis
NIOSH 2002 Oct; 1-10
The aim of this study was to systematically investigate the conditions under which upper room air ultraviolet germicidal irradiation (UVGI) systems can be expected to mitigate the spread of TB within indoor environments.
Worker Health Chartbook 2004: Tuberculosis
DHHS (NIOSH) Publication No. 2004-146
Provides data for incidence rates of TB in health care workers, 1994-2000.
Violence
NIOSH-funded study looks at violence among emergency department workers.
PDF Only 589 KB (34 pages)
External ink:
http://www.state.nj.us/health/eoh/survweb/documents/njhospsec_rpt.pdf
Workplace Violence and Prevention in New Jersey Hospital Emergency Departments. A summary report on 50 New Jersey Hospitals participating in the evaluation of California initiative to reduce violence against healthcare workers.
Violence: Occupational Hazards in Hospitals
DHHS (NIOSH) Publication No. 2002-101 (April 2002)
En español
All hospitals should develop a comprehensive violence prevention program. No universal strategy exists to prevent violence. The risk factors vary from hospital to hospital and from unit to unit. Hospitals should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All hospital workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.
Relation Between Policies and Work Related Assault: Minnesota Nurses' Study
Occup Environ Med 2005 Oct: 62(10):675-681
The purpose of this study was to assess the relationship between violence prevention policies and work-related assaults. In Phase 1, a population-based survey of 6,300 Minnesota nurses revealed that 13% experienced work-related physical assault within the past year. In Phase 2, a case-control study, 1,900 nurses were questioned about exposures relevant to violence and elements of violence prevention policies. Based on the findings, it appears that some work-related violence policies may be protective for this group of nurses.
Reducing Assaults Against Nursing Home Caregivers
Nurs Res 2005 Mar-Apr; 54(2): 119-127
The objective of this study was to test the effectiveness of a violence- prevention intervention, on the basis of Social Cognitive Theory to increase knowledge, self-efficacy and skills, and to decrease assaults.
NIOSH Alert: Preventing Homicide in the Workplace
DHHS (NIOSH) Publication No. 93-109 (May 1995)
En español
The purposes of this Alert are to identify high-risk occupations and workplaces, inform employers and workers about their risk, encourage employers and workers to evaluate risk factors in their workplaces and implement protective measures, and encourage researchers to gather more detailed information about occupational homicide and to develop and evaluate protective measures.
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