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HEALTH CARE WORKERS - What about Their Health?

by Mary Erio
Original material ©2001 by Mary Erio. May be reprinted with attribution by noncommercial sources. Presented in audio format on the August 16  Heartland Labor Forum radio show. 

While health care workers toil tirelessly to heal and comfort the nation’s ill, little attention has been focused on securing the health and safety of these critical workers.  According to an American Nurses Association publication, at health care workers currently represent 8 percent of the U.S. workforce.  More than 10 million people are employed in healthcare industries in occupations ranging for doctors to pharmacists to dental assistants, dietary and maintenance workers.  Nearly 80 percent of the health care workforce is female.           

Health care is rapidly becoming one of the most dangerous industries in the United States.  While the incidence rate of injury to all workers has declined since 1991, the rate of injuries to health care workers has continued to climb.  The number of reportable injuries and illnesses per 100 full time workers is now higher in a hospital, or in a nursing home than in construction or mining. 

Health care has lagged behind other industries in progress toward protecting workers.  The first OSHA standard aimed specifically at protecting health care workers was the 1991 Bloodborne Pathogens Standard.  The second standard to protect health care workers, the OSHA Tuberculosis Standard, which exists in provisional form, remains bogged down by politics after 8 years in progress.  Reasons for the lack of attention to health care worker health and safety may include the focus on the curative rather than preventive health in the hospital environment, according to the ANA.  The ANA article points out the focus within the field of occupational health on traditionally male occupational hazards rather than those impacting female workers. 

Few workplaces are as complex as a hospital.  Other health care settings, such as dental offices and nursing homes, present similarly complicated work environments.  Here are some hazards facing health care workers:

                     Biological and Infectious hazards, including bacteria such as tuberculosis, and viruses such as HIV, Hepatitis B and Hepatitis C,

                     Chemical hazards such as medications, or gases such as ethylene oxide, formaldehyde, glutaraldehyde, waste anesthetic gases, chemo - agents, and laser smoke.  An estimated 10 percent of health care workers are allergic to protective latex gloves.

                     Physical hazards such as ionizing radiation, lasers, noise and electricity.

                     Ergonomic hazards such as patient transfer and lifting.

                     Psychosocial hazards such as short staffing, stress, mandatory overtime and shift work, and finally,

                     Workplace violence occurs more often in health care and social service industries than any other industry, according to the Bureau of Labor Statistics. 

Later in the show, I’ll be talking about a some of these serious hazards, and what is being done about them. 

NEEDLESTICK PREVENTION 

In September 1992, three months out of nursing school, Lynda Marie Arnold was working as a registered nurse in the Intensive Care Unit at the Community Hospital of Lancaster Pennsylvania.   Although Lynda followed all of the recommended precautions, she received a needlestick while removing a catheter needle from the vein of a dying AIDS patient, after the patient suddenly moved his arm.  She tested positive for HIV six months later.  Lynda describes her emotional devastation on the website she started, found at bizsafe.com.  Even after she quit her job in 1994 due to failing health, she has fought for better standards to protect health care workers against needlestick injuries. 

In 1994, Lynda filed a lawsuit against Becton Dickinson Vascular Access, Inc., the maker of the IV catheter, partially to draw public attention to the problem.  Lynda never got her day in court; in January 1996, a judge granted Becton-Dickenson’s motion for summary judgement. 

Lynda was one of 133 health care workers identified by the Centers for Disease Control through June,1995 who had been occupationally infected by HIV.  Every year, from 600,00 to 800,000 health care workers are accidentally stuck by a needle or other sharp medical device.  At least 1,000 of these workers contract potentially life -threatening infections, like HIV, Hepatitis B and Hepatitis C. 

Despite the fact that safer devices, such as self sheathing needles, have been available since the 1970's and that 80 percent of needle stick injuries can be prevented through their use, fewer than 15 percent of U.S. hospitals have switched over to these safer devices as of last year, except where state laws require them. 

That is why Lynda Marie Arnold, and other nurses with similarly tragic histories, along with nursing organizations, have fought for laws to strengthen OSHA requirements. 

On November 6, 2000, health care workers scored a victory when Congress unanimously passed the “Needlestick Safety and Prevention Act.”  The Act directed OSHA to revise its Bloodborne Pathogens standard to describe in greater detail its requirement for employers to identify and make use of effective and safety medical devices.  The revision also gives nurses more say in the workplace by requiring facilities to seek their input when selecting and evaluating safer devices, like needles that automatically retract after use.  The law also requires employers to maintain a sharps injury log.  For more information on the revised standard, the OSHA website at contains a variety of resources for health care workers. 

The OSHA standard was effective on April 18, 2001.  Secretary of Labor, Elaine Chao delayed enforcement of the new provision until July 17 while OSHA conducted an educational outreach program.  While OSHA does not name any specific manufacturer, you can find information on a wide variety of specific products at many websites, including www.sustainablehospitals.org.

Nursing Home Industry - One of America’s fastest growing industries 

Employee population in the nursing home industry grew by nearly 50 percent between 1982 and 1992. Today nursing homes and personal care facilities employ approximately 1.6 million workers at 21,000 work sites. By the year 2005, industry employment levels will rise to an estimated 2.4 million workers. Approximately 10 percent of the employees are represented by unions. The two largest employee representatives are Service Employees International Union and the United Food and Commercial Workers Union. 

According to the Bureau of Labor Statistics, in 1994 nursing and personal care facilities reported 221,200 nonfatal occupational injuries and illnesses to their personnel. Among U.S. industries with 100,000 or more nonfatal injury or illness cases, nursing homes have the third highest rate of injuries and illnesses per 100 full‑time workers. Only meat products processing and motor vehicle/equipment manufacturing have higher incidence rates. Nursing home workers suffer most of their injuries when handling residents.  While back injuries account for 27 percent of all injuries in the private sector, in nursing homes they account for 42 percent of all injuries.  Almost 5,000 injuries were the result of assaults. 

The patient’s right to privacy at times might conflict with employee safety.  Many regulations of the Health Care Financing Administration assure residents a level of privacy similar to that which they would enjoy in their homes. Evaluations of workplace safety issues in the nursing homes generally involve some injuries related to the employees' handling residents. The resident handling activities may take place in resident rooms, restrooms, shower and bathing areas. Documenting these actual activities by witnessing, videotaping, and photography requires the resident's consent. 

Working conditions that may contribute to the risk of accidents include reduced lighting in resident rooms during sleeping hours, solo transfers of non-ambulatory residents without lift assist devices, broken equipment, wet floors, cramped working spaces and staffing levels inadequate to deal with the workload during high activity periods. An additional area of concern which should be addressed on the profile is the problem of combative residents who strike out at employees during interactions. 

Many nursing home employers already have learned that working safely is a good way to not only help protect their employees, but also affect the bottom line. When one nursing home employer implemented a program to address safe resident handling, worker's compensation premium dropped from $750,000 to $184,000. A similar resident handling program at another nursing home led to a striking reduction in lost workdays—from 2,200 in 1993 to only 31 in 1996. 

OSHA has many resources available to nursing home employers and employees.  During 1998, OSHA launched a nursing home initiative as part of the High Injury Rate Targeting and Cooperative Compliance Programs.  The OSHA website, at contains a nursing home eCAT, or electronic compliance assistant, with a graphical menu to identify hazards and controls in the nursing home industry.

WASTE ANESTHETIC GASES 

Anesthesia is as common to medical care as is antiseptic care of wounds.  However, for too long, exposure to and control of waste anesthetic gases (or WAGS) and vapors during surgical procedures have put health care workers in jeopardy.  At any given time more than 250,000 people who work in hospitals, operating rooms, dental offices, and veterinary clinics, might be exposed to harmful levels of WAGS.  Anesthetic gases of concern include nitrous oxide, halothane and other halogenated vapors.  Potential effects include spontaneous abortions, congenital abnormalities in children, and effects on the liver and kidneys. 

OSHA has determined that a complete Waste Anesthetic Gas management program should reduce employee exposure to well below Exposure Limits recommended by the National Institute of Occupational Safety and Health.  OSHA does not have exposure limits for nitrous oxide or halothane.  The program includes; a well designed scavenging system, which is generally included with modern anesthesia equipment.  The remainder of the management program includes work practices to minimized gas leakage, a routine equipment maintenance program, and the provision of general ventilation.   Exposure monitoring for the anesthetic gases in use should be conducted on a periodic basis. 

Finally, a medical surveillance program should be made available to all employees who are subject to occupational exposure to WAGS.  As an employee, you have a right to access you medical and exposure records. 

More information about anesthetic gases and health care safety in general can be found at under health care topics.  Many resources and links can also be found at the New York Coalition of Occupational Safety and Health website at www.nycosh.org.