CONTINUING EDUCATION

Hazards for the healthcare worker lurk around every corner. Needlesticks, slippery floors, volatile patients and their families, and exposure to toxic chemicals are just a few of the dangers that await the employee who is careless, naïve, or just unlucky. The endoscopy suite offers additional risks, related to endoscope reprocessing and to rushing to get one patient out and another patient in for the next procedure.

In this article, we will address sharps safety, environmental safety, personal protective equipment, and physical and emotional abuse directed at the healthcare worker by patients, their families, and fellow employees.

The consequences of a sharps injury can include acquisition of hepatitis B virus (HBV) or hepatitis C virus (HCV), human immunodeficiency virus (HIV), or other bloodborne pathogens.

It is possible to reduce these incidents, simply by adopting recommendations that combine with existing programs for performance improvement, infection control and safety. The CDC offers a model of a systematic, organization-wide approach for continually improving all processes involved in the delivery of quality products and services. It incorporates two elements -- organizational steps to develop and implement a SIPP, and operational processes.

In 2004, the CDC released its Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. The workbook outlines each step required in the process of reworking your sharps injury prevention program (SIPP).

Because employees with a sharps injury must undergo both initial and follow-up treatment after a stick, costs can range from $500 to $3,000 per incident; however, these numbers do not include the emotional toll on the employee, drug toxicity and lost time from work, and the cost to society if there is a seroconversion to HIV or HCV, which may include the worker’s inability to work with patients, the cost of medical care for these conditions, or the cost of litigation due to the stick or the seroconversion.

Data from the National Surveillance System for Healthcare Workers (NaSH) indicate that nurses suffer the greatest number of percutaneous injuries. But other groups at risk include patient care providers such as physicians and technicians, laboratory staff, and support personnel, including housekeeping. Although nurses account for the greatest numbers, simply because they are often the largest division of the hospital staff, non-nursing job roles sometimes reflect a higher rate of injury when injury rates are calculated based on the number of employees.

Occupational health and safety within the healthcare community has evolved, but current requests from professional societies are not being met by the majority of healthcare workers. There remains an ongoing debate on annual influenza immunizations, and the prospect of mandatory immunizations looms large. Employees may eventually face threats of termination if they continue to ignore the recommendations to be immunized against influenza, which they can acquire, pass on to their coworkers, or pass on to patients. An influenza epidemic could drastically reduce the number of employees available to treat patients who have contracted the same illness, and could create a healthcare crisis.

The CDC has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984, and for all HCWs since 1993.1 The flu causes 200,000 hospitalizations and 36,000 deaths annually nationwide.

Occupationally acquired infectious diseases are a recognized peril among HCWs. Moreover, the estimated annual death rate for HCWs from occupational events — including infection — is 17 to 57 per 1 million workers.

Influenza vaccination has been proven to reduce influenza infection in HCWs by 88 percent and decreases work absence due to respiratory illness by 28 percent. Still, annual influenza immunization rates among HCWs in the United States remain poor, despite the known risk. In fact, coverage among HCWs in the United States in 2003 was 40.1 percent.

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