Prevention of Injury at Work: Promoting Staff Health and Psychological Well-being. Susan Goodwin Gerberich, PhD University of Minnesota, USA

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1 Prevention of Injury at Work: Promoting Staff Health and Psychological Well-being Susan Goodwin Gerberich, PhD University of Minnesota, USA

2 OVERVIEW Healthcare Workforce: Globally and in the United States Occupational Health and Safety Legislation Injury: Unintentional and Intentional (Violence) Definitions Magnitude Risk Factors Costs Strategies for Prevention and Control

3 HEALTHCARE WORKERS GLOBALLY: 59 Million Workers UNITED STATES (U.S.): 18 Million Workers Shortage Of Healthcare Workforce

4 OCCUPATIONAL SAFETY AND HEALTH ACT The Occupational Safety and Health Act s (OSH Act) General Duty Clause requires employers to provide a safe and healthful workplace one that is free from recognized hazards that are causing or likely to cause death or serious physical harm Employers who do not take reasonable steps to prevent or abate a recognized violence or other hazard in the workplace can be cited. Law ; 84 STAT.1590; 91st Congress, S.22193, December 29, 1970; 2004

5 INJURY DEFINITION involves damage to the body caused by exchanges with acute exposures to environmental energy that are beyond the body s resilience Energy may be: chemical; electrical; radiant; nuclear; thermal; and mechanical (kinetic 75% of injuries) may be either unintentional or intentional (assault, homicide, or suicide) occurs as a result of dynamic interaction between the energy and the individual/groups within the environment is work-related if an event or exposure in the work environment caused or contributed to the resulting condition

6 OCCUPATIONAL INJURIES AND ILLNESSES* INVOLVING LOST WORK DAYS - U.S. *95% = Injuries; only the most severe included and does not account for workers who continue to work on modified duty U.S. Bureau of Labor Statistics Occupational Safety and Health Administration

7 Occupation Healthcare practitioners and technical occupations NON-FATAL OCCUPATIONAL INJURIES* AND ILLNESSES, INVOLVING LOST WORKDAYS UNITED STATES, 2013 TOTAL PRIVATE, STATE, LOCAL GOVERNMENT Number: Unintentional and Intentional Incidence Rate Per 10,000 Full-Time Workers 64, Median Days Away From Work Healthcare support occupations 69, TOTAL 134,030 ( 253,700 recorded) *Injuries = 95% Bureau of Labor Statistics 2015

8 U.S. HOSPITALS ARE AMONG THE MOST HAZARDOUS PLACES TO WORK HEALTHCARE WORKERS: 253,700 recorded work-related injuries and illnesses (6.8 versus 3.5 per 100 full-time employees for all industry) Nearly 50 percent of injuries among nurses and nursing support staff were musculoskeletal disorders; (overexertion injury rate, 76 versus 38/10,000 full time workers for all industry) Past 10 years - average: experienced over 50% of all industry reported nonfatal violence-related injuries involving lost work days 2014: ~80% of nurses reported being attacked on the job within the past year; accounted for ~70% of all reported industry nonfatal violence-related injuries involving lost work days U.S. Bureau of Labor Statistics

9 TOP FIVE CAUSES OF INJURIES AMONG U.S. HOSPITAL WORKERS U.S. Bureau of Labor Statistics Occupational Safety and Health Administration 2013

10 RATES OF INJURIES RESULTING IN DAYS AWAY FROM WORK FOR SELECTED HEALTHCARE OCCUPATIONS, U.S. U.S. Bureau of Labor Statistics Occupational Safety and Health Administration 2013

11 CAUSES OF INJURIES RESULTING IN DAYS AWAY FROM WORK FOR SELECTED HEALTHCARE OCCUPATIONS U.S. Bureau of Labor Statistics Occupational Safety and Health Administration 2013

12 CAUSES OF FATAL WORKPLACE INJURIES IN HOSPITALS, Transportation 37% Violence - 29% TOTAL = 263 OVER NINE YEARS: ~ 29 FATALITIES/YEAR U.S. Bureau of Labor Statistics Occupational Safety and Health Administration 2013

13 POTENTIAL RISK FACTORS FOR INJURIES AMONG HEALTHCARE WORKERS PHYSICAL AND PSYCHOLOGICAL DEMANDS Workplace Safety Culture: Administrative Support and Resources; Relevant Training Programs; Workload/ Staffing; Patient/Nurse Ratios Environment: Collegial/Supportive; Respectful; Physical workspace; lighting; design; noise levels; safety of equipment Handling patients; direct patient care Shiftwork: evening, night, and rotating day and night Miller, Risk factors and impacts of occupational injury OA Musculoskeletal Medicine 2013

14 FOCUS ON FOUR MAIN CAUSES OF INJURIES AMONG U.S. HOSPITAL WORKERS TYPE OF INJURY % INVOLVED Overexertion and Bodily Reaction 48% (Musculoskeletal Disorders) Slips, Trips and Falls 25% Contact with Objects 13% (Needlestick and Sharps Injuries) Violence 9-11%

15 PATIENT HANDLING INJURIES CAN BE VERY COSTLY LARGE NATIONAL SURVEY AMONG 53 HEALTHCARE SYSTEMS, ~1,000 HOSPITALS IN ALL 50 STATES 2011 Patient handling injuries: 25 percent of all workers compensation claims for the healthcare industry Initial capital investment in safe patient handling policies, programs, and equipment can be recovered in fewer than five years

16 SAFE PATIENT HANDLING IS EFFECTIVE IN REDUCING WORKER INJURIES AND LOST TIME Minimal lifting replaces manual lifting, transferring and repositioning of patients with mechanical or other patient-assist devices

17 COST SAVINGS IMPLEMENTATION OF SAFE LIFTING PROGRAMS Reduction of lost time days by 83% (in 3 years) Cincinnati Children s Hospital Reduction of patient-handling injuries by 65% / costs by 92% Tampa General Hospital Reduction of turnover of older nurses by 48% / saved $170K South Carolina Hospital Five-Year Net Savings of $2.2 Million with $800,000 Investment Stanford University Medical Center

18 Nurse and Health Care Worker Protection Act of 2013 Summary: H.R th Congress ( ) Requires the Secretary of Labor to promulgate an interim final standard on safe patient handling, mobility, and injury prevention to prevent musculoskeletal disorders for directcare registered nurses and all other health care workers that requires the use of engineering and safety controls to handle patients through the use of mechanical technology and devices where feasible. Bill introduced on June 25, 2013, but not enacted.

19 SLIP, TRIP, AND FALL PREVENTION FOR HEALTHCARE WORKERS

20 STF claim rate per 100 workers SLIP, TRIP, AND FALL (STF) PREVENTION PROGRAM FOR HEALTHCARE WORKERS Pre-Intervention Intervention phase Post-Intervention phase Workers Compensation claims declined 59% after implementation of comprehensive program in three acute-care hospitals. Bell et al. (NIOSH)

21 RISKS AND COSTS OF NEEDLESTICK AND SHARPS INJURIES AMONG HEALTHCARE WORKERS ~385,000 needlesticks and other sharps-related injuries each year 50% or more of healthcare personnel do not report these injuries Associated with transmission of 20+ pathogens Costs include the direct costs associated with the initial and follow-up treatments of exposed healthcare personnel: range ~ $70 to $5,000, depending on the treatment provided Exposure Prevention Information Network

22 RISK OF NEEDLESTICK AND SHARPS INJURIES AMONG HEALTHCARE WORKERS OCCURRENCE: 15% During or related to device disposal 5% During device recapping 40% During device use 40% After device use, before disposal

23 RISK OF NEEDLESTICK AND SHARPS INJURIES AMONG HEALTHCARE WORKERS DEVICES INVOLVED: Glass (2%) Other/unknown (4%) Suture needle (20%) Hollow-bore needle (56%) (hypodermic needle, winged-steel needle, IV stylet, phlebotomy needle, other hollow bore needle) Scalpel (8%) Other (10%) Solid Sharp (38%)

24 PREVENTION OF NEEDLESTICK AND SHARPS INJURIES AMONG HEALTHCARE WORKERS EVALUATE AND PROVIDE DEVICES DESIGNED TO PREVENT INJURY: Syringes with sliding sheaths that engage after use Needles that retract after use Shielded or retracting catheters IV delivery systems with catheter ports/needles in protective coverings Safety scalpels with sliding shields

25 VIOLENCE AGAINST HEALTHCARE WORKERS Physical Assault: occurs when subjected to physical contact intended to injure or harm Non-Physical Violence: threat; sexual harassment; verbal abuse; and bullying 2014: ~80% of nurses reported being attacked on the job Even more threatened or exposed to verbal and other aggression

26 VIOLENCE AGAINST HEALTHCARE WORKERS POPULATION-BASED STUDY OF NURSES (RNS AND LPNS) Identify the magnitude, consequences and associated risk factors Cohort of 6,300 nurses randomly sampled from a state licensing database (78,000 total) Adjusted Rates per 100 persons per year for physical assault (13.2 [12.2, 14.3]) and non-physical violence (38.8 [37.4, 40.4]) rates (Odds Ratios and 95% C.I.s) Gerberich et al. Violence against nurses

27 SUMMARY OF FINDINGS: RISK* AND PROTECTIVE* FACTORS THAT CAN SERVE AS A BASIS FOR PREVENTION EFFORTS Violence, both physical and non-physical, is a significant problem among nurses Including: post-event physical and psychological problems; change in work status: restriction; quitting; transferring Environmental exposures associated with increased risk:* Working in: nursing homes/long term care facilities (2.6) emergency (4.2)/psychiatric/behavioral departments (2.0) environments with lighting less than bright as daylight (2.2) Environmental exposures associated with decreased risk:* Working in outpatient, clinic and public health facilities ( ) Working with neonatal/pediatric/adolescent populations (0.4) Carrying a cell phone/personal alarm ( ) *Case (n=475) Control (n=1425) Study: Statistically Significant Odds Ratios Gerberich et al., Violence against nurses

28 TOTAL WORKER HEALTH TM Total Worker Health is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. is more than the sum of it parts protection and promotion it is a synthesis of all aspects of health that create worker well-being John Howard, MD, Director National Institute for Occupational Safety and Health (NIOSH)

29 PREVENTION OF INJURY AT WORK - PROMOTING STAFF HEALTH AND PSYCHOLOGICAL WELL-BEING BASELINE AND ONGOING RECORD-KEEPING Events and Interventions OCCUPATIONAL SAFETY AND HEALTH PROTECTION AND HEALTH PROMOTION Provide Relevant: Engineering Controls; Safety and Security Technologies; Workplace Design/Environment; Adaptations for Workers; Human Resources WORKSITE ANALYSIS Identify and Assess Hazards MANAGEMENT COMMITMENT, LEADERSHIP, AND RESOURCES EMPLOYEE INVOLVEMENT HEALTH AND SAFETY COMMITTEE TOTAL WORKER HEALTH TM Approach Occupational Safety and Health Protection and Health Promotion Policy and Program Development, Implementation, and Evaluation Ongoing Oversight REGULAR DATA REVIEW Analyze Trends and Rates of Injuries/Fatalities Relative to Initial or Baseline Rates EVALUATION AND MODIFICATION Policies, Programs, and Interventions EMPLOYEE SAFETY AND HEALTH TRAINING Provide Tools to Identify Workplace Safety and Security Hazards Gerberich (adapted)

30 A UNIVERSAL TRUTH: NO HEALTH WITHOUT A WORKFORCE SHORTAGE OF GLOBAL (U.S.) HEALTH WORKFORCES: 2014: 7.2 (2.2) Million Workers 2035: 12.9 (3.9) Million Workers

31 HEALTHCARE WORKERS ARE VALUABLE! Google Images

32 THE BEST WAY TO SOLVE OCCUPATIONAL HEALTH PROBLEMS IS TO FIX THE WORKPLACE, NOT JUST THE WORKER. PROVIDE A SAFE AND HEALTHY WORKPLACE!

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