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NIOSH hazard review: Occupational hazards inOccupational hazards in

home health

April 1, 2009

Session SCH296Presented by Laura Hodson, MSPH, CIH

NIOSH Hazard Review: NIOSH Hazard Review: Occupational Hazards in Occupational Hazards in

Home HealthcareHome Healthcare

OSC 09Ohio Safety Congress & Expo

Laura L. Hodson, MSPH, CIHLaura L. Hodson, MSPH, CIHNational Institute for Occupational Safety and HealthNational Institute for Occupational Safety and Health

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

The findings and conclusions in this presentation have not been formally disseminated The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be by the National Institute for Occupational Safety and Health and should not be

construed to represent any agency determination or policyconstrued to represent any agency determination or policy

The National Institute for The National Institute for Occupational Safety and HealthOccupational Safety and Health

The U.S. Federal agency responsible for The U.S. Federal agency responsible for conducting researchconducting research and and making making recommendationsrecommendations for the prevention of for the prevention of workwork--related injury and illnessrelated injury and illnessworkwork--related injury and illness.related injury and illness.

Mission: Generate new knowledge; convert Mission: Generate new knowledge; convert research to practice; and collaborate globally research to practice; and collaborate globally to prevent workto prevent work--related illnesses and injuries related illnesses and injuries

Home Healthcare WorkersHome Healthcare WorkersHealth care aidesHealth care aidesPhysical, occupational and speech Physical, occupational and speech therapiststherapistsSocial workersSocial workersSocial workersSocial workersHospice care workersHospice care workers

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Home Healthcare WorkersHome Healthcare WorkersOver 896,000 U.S. workers (BLS 2007)Over 896,000 U.S. workers (BLS 2007)>90% female>90% female>25% are over the age of 55>25% are over the age of 55> 25% speak a language other than > 25% speak a language other than > 25% speak a language other than > 25% speak a language other than English at home English at home

Predicted to grow 55% by 2016Predicted to grow 55% by 2016–– Growing demand from aging population Growing demand from aging population –– Change in hospital staysChange in hospital stays

Uniqueness of Safety and Health RisksUniqueness of Safety and Health Risks

Provide services in patients home Provide services in patients home 24/724/7Personal safety in communityPersonal safety in communityW k i t t b d W k i t t b d Work environment may not be under Work environment may not be under the control of the employer (for the control of the employer (for example, snow removal)example, snow removal)Patient rights to control their own Patient rights to control their own home (pets, guest, hygiene, home (pets, guest, hygiene, equipment, etc.)equipment, etc.)

Brief OverviewBrief OverviewSafety and health risksSafety and health risksSuggested solutions for Suggested solutions for employers and employeesemployers and employees

Hazard Review: Occupational Hazard Review: Occupational Hazards in Home HealthcareHazards in Home HealthcareNIOSH 2009NIOSH 2009--XXX. XXX. Coming Coming soonsoon

Overview of risks we will discussOverview of risks we will discussMusculoskeletal disordersMusculoskeletal disordersLatex exposureLatex exposureBloodborne pathogensBloodborne pathogensOccupational stressOccupational stressViolenceViolenceViolenceViolenceInfectious diseaseInfectious diseaseAnimals & home hygieneAnimals & home hygieneFallsFallsCommunity emergenciesCommunity emergenciesDrivingDriving

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Musculoskeletal Disorders (MSDs)Musculoskeletal Disorders (MSDs)Sprains and strains were most common Sprains and strains were most common lostlost--time injury in 2007time injury in 2007Single person Single person Rooms may be crowdedRooms may be crowdedBeds may not be adjustableBeds may not be adjustablePatient assist devices may not be in homePatient assist devices may not be in homePatient may be connected to catheter, IV Patient may be connected to catheter, IV or other equipment resulting in awkward or other equipment resulting in awkward postures for workerspostures for workers

MSD Suggestions for employersMSD Suggestions for employersImplement an ergonomic intervention Implement an ergonomic intervention programprogramProvide trainingProvide trainingProvide ergonomic assist devices Provide ergonomic assist devices Provide ergonomic assist devices Provide ergonomic assist devices ResourceResource-- NIOSH Safe Lifting and NIOSH Safe Lifting and Movement of Nursing Home ResidentsMovement of Nursing Home ResidentsResourceResource-- US Veterans Administration US Veterans Administration Patient Safety Center of InquiryPatient Safety Center of Inquiry

MSD Suggestions for employeesMSD Suggestions for employeesUse ergonomic assistive devices.Use ergonomic assistive devices.Use good body mechanicsUse good body mechanics–– Stand close to patient, keep back straightStand close to patient, keep back straight–– Raise a patients knees and ask them to push if Raise a patients knees and ask them to push if p pp p

they need to be pulled up in the bedthey need to be pulled up in the bed–– Apply antiApply anti--embolism stocking by pushing them embolism stocking by pushing them

on while standing at the end of the bedon while standing at the end of the bed–– Use antiUse anti--friction devices and gentle rocking friction devices and gentle rocking

motions to move patientsmotions to move patients

Ergonomic Assist DevicesErgonomic Assist Devices

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Additional ergonomic assist Additional ergonomic assist equipmentequipment Latex ExposureLatex Exposure

Irritant contact dermatitisIrritant contact dermatitis––Dry itchy skinDry itchy skin

Allergic contact dermatitis (delayed Allergic contact dermatitis (delayed hypersensitivity)hypersensitivity)hypersensitivity)hypersensitivity)––Rash and oozing blistersRash and oozing blisters

Latex allergy (immediate Latex allergy (immediate hypersensitivity)hypersensitivity)––Redness of skin, runny nose, itchy eyes, Redness of skin, runny nose, itchy eyes,

asthma, potentially shockasthma, potentially shock

Suggestions for employersSuggestions for employersGood for both workers and patientsGood for both workers and patientsProvide trainingProvide trainingProvide non latex gloves. If there is the Provide non latex gloves. If there is the potential for contact with infectious potential for contact with infectious potential for contact with infectious potential for contact with infectious materials then use gloves that pass the materials then use gloves that pass the ASTM F1671 penetration test for ASTM F1671 penetration test for bloodborne pathogens.bloodborne pathogens.Consider all uses of latex (other medical Consider all uses of latex (other medical products such as catheters, syringes, vial products such as catheters, syringes, vial tops, stethoscopes, electrode pads)tops, stethoscopes, electrode pads)

Suggestions for employeesSuggestions for employeesUse non latex gloves for activities Use non latex gloves for activities with nonwith non--infectious materials.infectious materials.Learn the symptoms of latex allergyLearn the symptoms of latex allergyIf d l t tif If d l t tif If you develop any symptoms, notify If you develop any symptoms, notify your employer and your doctor. your employer and your doctor. Avoid all latex contact until you have Avoid all latex contact until you have seen your doctor.seen your doctor.

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Bloodborne PathogensBloodborne PathogensContaminated sharp injuries place health Contaminated sharp injuries place health care workers at risk of potentially life care workers at risk of potentially life threatening diseases such as hepatitis and threatening diseases such as hepatitis and HIV HIV Needlestick and other sharps and blood Needlestick and other sharps and blood exposure may occur in the home setting exposure may occur in the home setting from from –– Improper disposal of needlesImproper disposal of needles–– Distractions Distractions –– Sudden profuse bleeding of woundsSudden profuse bleeding of wounds

Suggestions for employersSuggestions for employers

Highly regulatedHighly regulated--–– Follow the OSHA Bloodborne Pathogens Follow the OSHA Bloodborne Pathogens

Regulation 29CFR 1910.1030Regulation 29CFR 1910.1030––Comply with your state medical waste Comply with your state medical waste Comply with your state medical waste Comply with your state medical waste

requirementsrequirements

Select medical devices with safety Select medical devices with safety featuresfeaturesProvide employees with sharps Provide employees with sharps containerscontainers

Suggestions for employeesSuggestions for employeesParticipate in your employers bloodborne Participate in your employers bloodborne pathogens program.pathogens program.Complete the HBV vaccine seriesComplete the HBV vaccine seriesSecure the immediate area around patient Secure the immediate area around patient b f h dli dl d th hb f h dli dl d th hbefore handling needles and other sharpsbefore handling needles and other sharpsImmediately report any needlestick or Immediately report any needlestick or sharps injurysharps injurySecure sharps containers during Secure sharps containers during transporttransport

Occupational StressOccupational StressHospice care, dying patientsHospice care, dying patientsWorkload and time pressuresWorkload and time pressuresEmphasis on cost containmentEmphasis on cost containmentPatient aggressionPatient aggressionDisorientated, irritable or Disorientated, irritable or uncooperative patientsuncooperative patients

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Suggestions for employers Suggestions for employers Provide trainingProvide trainingProvide quality supervision and supportProvide quality supervision and supportHold regular meetings Hold regular meetings Allow sufficient time for meals and travelAllow sufficient time for meals and travelAllow sufficient time for meals and travelAllow sufficient time for meals and travelApply organizational interventions and/or Apply organizational interventions and/or worker focused interventionsworker focused interventions––Coping strategies, progressive Coping strategies, progressive

relaxation, biofeedback, time relaxation, biofeedback, time managementmanagement

Suggestions for employeesSuggestions for employeesDevelop effective coping skills, try to Develop effective coping skills, try to put a positive spin on thingsput a positive spin on thingsAllow travel timeAllow travel timeT k l h b kT k l h b kTake lunch breaksTake lunch breaksPerform relaxation techniquesPerform relaxation techniquesDiscuss the stresses with coDiscuss the stresses with co--workers workers and supervisorsand supervisors

ViolenceViolence330 nonfatal assaults in 2006330 nonfatal assaults in 2006Unfamiliar communities and lifestylesUnfamiliar communities and lifestylesPotential to encounter alcohol or Potential to encounter alcohol or d b fi b l bd b fi b l bdrug abuse, firearms, verbal abusedrug abuse, firearms, verbal abuseWorkers mustWorkers must often resolve problems often resolve problems on their ownon their ownWorkers may not report Workers may not report violent behaviorviolent behavior

Suggestions for Employers Suggestions for Employers Violence ReductionViolence Reduction

Provide trainingProvide trainingDevelop written policies for reporting Develop written policies for reporting violence and for reporting incidents to violence and for reporting incidents to police.police.D l li i i th hD l li i i th hDevelop policies on weapons in the homeDevelop policies on weapons in the homeKeep close track of employee’s schedulesKeep close track of employee’s schedulesProvide cell phonesProvide cell phonesWork with social workers and families to Work with social workers and families to improve immediate conditionsimprove immediate conditions

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Suggestions for EmployeesSuggestions for EmployeesViolence ReductionViolence Reduction

Learn how to identify signs and body Learn how to identify signs and body language associated with violent assaultlanguage associated with violent assaultLearn verbal deLearn verbal de--escalation techniquesescalation techniquesCarry a cell phoneCarry a cell phoneCarry a cell phoneCarry a cell phoneHave good directions ahead of timeHave good directions ahead of timePark away from bushes and in good lightPark away from bushes and in good lightLock extra equipment in the car trunkLock extra equipment in the car trunkIf you feel uncomfortable, leaveIf you feel uncomfortable, leave

Suggestions for Employees _ Suggestions for Employees _ Violence Prevention con’tViolence Prevention con’t

Diffuse angerDiffuse anger––Maintain a calm caring attitudeMaintain a calm caring attitude––Do not match threatsDo not match threats

Do not give ordersDo not give orders––Do not give ordersDo not give orders––Acknowledge the person’s feelingsAcknowledge the person’s feelings––Avoid getting too close, unnecessary Avoid getting too close, unnecessary

touching or speaking loudlytouching or speaking loudly

Infection ControlInfection ControlInfection control guidelines protect both Infection control guidelines protect both the worker and the patientthe worker and the patient

Employers shouldEmployers should–– Provide training and personal protective Provide training and personal protective

equipmentequipment–– Have a plan in case of pandemic fluHave a plan in case of pandemic flu

www.pandemicflu.govwww.pandemicflu.govwww.cdc.gov/flu/avianwww.cdc.gov/flu/avianOSHAOSHA--Pandemic flu preparedness and response Pandemic flu preparedness and response guidance for healthcare workers and healthcare guidance for healthcare workers and healthcare employers employers

Suggestions for Employers Suggestions for Employers ––Infection ControlInfection Control

Appoint an infection control nurse or Appoint an infection control nurse or managermanagerInclude training on standard Include training on standard precautionsprecautionsprecautionsprecautionsProvide training on hand hygiene and Provide training on hand hygiene and cough etiquettecough etiquetteProvide a means for staff to disinfect Provide a means for staff to disinfect or sterilize their equipmentor sterilize their equipment

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Suggestions for Employees Suggestions for Employees ––Infection ControlInfection Control

Follow your employers infection Follow your employers infection control plancontrol planUse appropriate PPE including Use appropriate PPE including medical exam gloves and respiratory medical exam gloves and respiratory medical exam gloves and respiratory medical exam gloves and respiratory protectionprotectionTrain patients, family members and Train patients, family members and home visitors on proper cough home visitors on proper cough etiquette.etiquette.

Home HygieneHome Hygiene

Non potable waterNon potable waterTemperature extremesTemperature extremesAnimalsAnimalsAnimalsAnimalsCleanliness (lice, roaches, fleas)Cleanliness (lice, roaches, fleas)

Suggestions for EmployersSuggestions for Employers--Improvement of Hygiene IssuesImprovement of Hygiene IssuesProvide trainingProvide trainingSet policies for restraint of animalsSet policies for restraint of animals

Provide cloths to set equipment onProvide cloths to set equipment onIf necessary work with social servicesIf necessary work with social services

Suggestions for EmployeesSuggestions for EmployeesBring cloths to set under equipmentBring cloths to set under equipmentDon’t place personal belongings on Don’t place personal belongings on the carpetthe carpetC id b i i t bl tC id b i i t bl tConsider bringing potable waterConsider bringing potable waterUse disposable gloves and hand Use disposable gloves and hand sanitizersanitizerNotify your employer Notify your employer

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Fall ProtectionFall ProtectionMore falls to home healthcare workers and More falls to home healthcare workers and hospital workers than general industryhospital workers than general industry–– 2007 injury incident rates caused by floors, 2007 injury incident rates caused by floors,

walkways or ground are 39.9, 36.2 and 24.3 walkways or ground are 39.9, 36.2 and 24.3 (per 10,000 workers) (per 10,000 workers) (p , )(p , )

Lack of control over the environment Lack of control over the environment –– Icy pavementIcy pavement–– Wet floorsWet floors–– Loose throw rugsLoose throw rugs–– Electrical cordsElectrical cords

Suggestions for EmployersSuggestions for Employers--Prevention of FallsPrevention of Falls

Provide training to raise awarenessProvide training to raise awareness

Suggest or require nonSuggest or require non--slip shoesslip shoes

Fall prevention is good for both Fall prevention is good for both employee and the patientemployee and the patient

Suggestions for EmployeesSuggestions for Employees-- Fall Fall ProtectionProtection

Wear sturdy flat slip resistant shoesWear sturdy flat slip resistant shoesWalk slowly on icy or wet surfacesWalk slowly on icy or wet surfacesTurn on lightsTurn on lightsUse handrailsUse handrailsDiscuss rearranging rugs, cords etc. Discuss rearranging rugs, cords etc. with patient to prevent employee with patient to prevent employee andand patient falls.patient falls.

Community EmergenciesCommunity EmergenciesSevere weather Severe weather ––TornadosTornados––HurricanesHurricanes––EarthquakesEarthquakes––BlizzardsBlizzardsChemical spillsChemical spillsActs of terrorismActs of terrorism

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Suggestions for EmployersSuggestions for Employers-- Safe Safe Response to Community EmergenciesResponse to Community Emergencies

Provide trainingProvide trainingFederal Emergency Management Federal Emergency Management Agency (FEMA) web site has lots of Agency (FEMA) web site has lots of Agency (FEMA) web site has lots of Agency (FEMA) web site has lots of good information on protective good information on protective measures for all types of weather, measures for all types of weather, evacuation and sheltering in place evacuation and sheltering in place episodes.episodes.

Automobile UseAutomobile UseDuring 2005, home healthcare workers During 2005, home healthcare workers were involved in over 1,200 accidentswere involved in over 1,200 accidents

The 2007 incidence rate for lost work days The 2007 incidence rate for lost work days The 2007 incidence rate for lost work days The 2007 incidence rate for lost work days from injuries caused by transportation from injuries caused by transportation accidents was more than 10 times higher accidents was more than 10 times higher for home health care workers than for for home health care workers than for hospital workers.hospital workers.

Suggestions for EmployersSuggestions for Employers--Automobile UseAutomobile Use

Employers shouldEmployers should––Enforce seat belt useEnforce seat belt use––Validate drivers licenses annuallyValidate drivers licenses annually

Require reporting of all accidentsRequire reporting of all accidents––Require reporting of all accidentsRequire reporting of all accidents–– Include fatigue management in safety Include fatigue management in safety

programsprograms–– Insure that company cars are regularly Insure that company cars are regularly

servicedserviced

Suggestions for EmployeesSuggestions for Employees--Automobile UseAutomobile Use

Workers shouldWorkers should––Use seat beltsUse seat belts––Avoid distractions while driving such as Avoid distractions while driving such as

cell phone use, eating, adjusting noncell phone use, eating, adjusting non--critical controlscritical controls

––Plot out the directions before leaving, Plot out the directions before leaving, consider use of a GPS for the vehicleconsider use of a GPS for the vehicle

––Service the care regularly Service the care regularly ––Maintain at least ¼ tank of fuelMaintain at least ¼ tank of fuel––Carry a car emergency kitCarry a car emergency kit

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ConclusionsConclusionsTrain employees!Train employees!

See the NIOSH document at:See the NIOSH document at:

http://www.cdc.gov/niosh/topics/hehttp://www.cdc.gov/niosh/topics/healthcare/althcare/

Hazard Review: Occupational Hazard Review: Occupational Hazards in Home HealthcareHazards in Home HealthcareNIOSH 2009NIOSH 2009--xxx xxx coming sooncoming soon

AcknowledgementsAcknowledgementsNIOSH Authors: Barbara Dames, NIOSH Authors: Barbara Dames, Bonita Malit M.D., Sherry Baron Bonita Malit M.D., Sherry Baron M.D., Christy Forrester, Traci M.D., Christy Forrester, Traci Galinsky PhD Laura Hodson Galinsky PhD Laura Hodson Galinsky PhD, Laura Hodson, Galinsky PhD, Laura Hodson, Henryka Nagy PhD, Kelley Parsons, Henryka Nagy PhD, Kelley Parsons, Naomi Swanson PhD, Tom Waters Naomi Swanson PhD, Tom Waters PhD and Joann Wess. PhD and Joann Wess.

More AcknowledgementsMore AcknowledgementsCritical review of the document was Critical review of the document was provided by the following NIOSH provided by the following NIOSH employees Michael Colligan, James Collins, employees Michael Colligan, James Collins, Paula Grubb, Regina PanaPaula Grubb, Regina Pana--Cryan PhD, Cryan PhD, Robert Peters and Edward Petronk, M.D. Robert Peters and Edward Petronk, M.D. External Reviewers include Steven External Reviewers include Steven Christianson, D.O., Catherine Galligan, Christianson, D.O., Catherine Galligan, Lisa Gorski, Elise Handelman, Tina Lisa Gorski, Elise Handelman, Tina Marrelli, Kathleen McPhaul, PhD, Doris Marrelli, Kathleen McPhaul, PhD, Doris Mosocco, Rosemary Soka, M.D. and Mosocco, Rosemary Soka, M.D. and Wayne Young.Wayne Young.

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Thanks for listeningThanks for listeningLaura HodsonLaura Hodson

lhodson@cdc.govlhodson@cdc.gov