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  • ACOEM Endorses NIOSH Survey of Health Care Workers’ Health and Safety Practices

    February 11, 2010

    John Howard, MD
    National Institute for Occupational Safety and Health (NIOSH)
    395 E. Street, S.W., Suite 9200
    Patriots Plaza Building
    Washington, DC 20201 

    Re: Survey of Health Care Workers’ Health and Safety Practices

    Dear Dr. Howard:

    ACOEM would like to endorse the proposal by NIOSH to survey healthcare workers' health and safety practices. While we have some suggestions regarding the survey instrument itself, as well as the targeted populations, ACOEM agrees with the general strategy of enlisting the participation of healthcare workers through their respective professional societies, and with the mission to gather additional data for the purposes of benchmarking, guideline development, and health and safety promotion.

    The professional societies listed in the survey tool encompass a wide range of healthcare workers with potential for chemical and other exposures. NIOSH may wish to consider including professional societies which would allow access to oncologists, surgeons, and medical intensivists as well, since all have some risk for chemical exposures. If there is interest in expanding the scope of the questionnaire to gather information about radiation exposures in healthcare institutions, NIOSH may also consider surveying interventional cardiologists, radiation oncologists, and interventional radiologists, as well as radiation-exposed nurses and technical personnel.

    In general, the survey instrument appears well laid out, and its online modular structure should allow it to be minimally intrusive and relatively time-efficient. It appears; however, based on the surveillance instrument we reviewed, that little attention is given to bloodborne pathogen exposures. So large-scale a survey of healthcare workers would provide an excellent opportunity to gauge reporting practices around bloodborne pathogen exposures, reasons for non-reporting; as well as general impressions regarding the adequacy of training programs, the provision of safety-engineered devices, and the frequency of prophylaxis with anti-retrovirals. While ACOEM understands that the emphasis of the survey appears to be on chemical exposures, it would seem a shame to pass up the opportunity to gather on so large a scale active surveillance around bloodborne pathogen exposures, particularly in light of the fact that most current surveillance instruments are passive in nature, e.g. they rely upon data gathered only when a healthcare worker chooses to report an exposure and seek medical evaluation.

    With respect to some details on the survey tool we reviewed, NIOSH may wish to consider gathering data not only from those administering aerosolized drug therapy, but also from those providing patient care for those receiving such therapy. In addition, given the tremendous morbidity suffered by healthcare workers from patient handling injuries, we would advise the gathering of some additional data about use of safe patient handling equipment. Specifically, it would be useful to know when lifting devices are not used, and why they are not used, e.g. not available, not enough time, couldn't find device, linen not available (slings/sheets), not trained, not comfortable using, didn't think it was necessary, instructed not to use it, etc. It would be extremely helpful to know nationally what proportion of healthcare workers who handle patients actually have lifting equipment available and have been properly trained in its use.

    Finally, we would caution NIOSH regarding the seasonal flu section. Since, at least to date, 2009 H1N1, rather than the seasonal strains, has been the circulating virus, healthcare workers taking the survey will be confused by the seasonal flu section. If there is a desire to gather information on PPE for 2009 H1N1 this season, the survey instrument should state that clearly. And the survey would need to take into account the difference between usual PPE recommendations for seasonal flu and the recommendations of this season for H1N1. It might be interesting to gather data regarding availability of respirators this season, since manufacturers and distributors were not able to meet the demands of hospitals seeking to comply with guidance from CDC and requirements from OSHA. It would also be useful to gather data in the influenza section on vaccination rates among healthcare workers.

    We are hopeful that NIOSH finds this feedback helpful. Again, we would emphasize that ACOEM applauds the overall project and shares with NIOSH the hope that it will foster continued improvements in the health and safety of those who work in medical centers.

    Pam Hymel - gif 
    Pamela Hymel, MD, FACOEM
    President, ACOEM