Posts Tagged ‘healthcare workers’

Readers reply: Premium comparison and safe patient handling

Friday, April 21st, 2006

State Premium Ranking – Thanks to Mike Manley for pointing us to the 2004 Oregon Workers’ Compensation Premium Rate Ranking Summary, which offers a comparison of premium by state. Mike is the Research Coordinator at the Information Management Division of Oregon’s Department of Consumer and Business Services. He also points us to some other workers comp studies that look very valuable – thanks, Mike.
Safe patient handling – Ann Hudson, RN, BSN commented on our recent post about Washington passes “Safe Patient Handling” legislation, noting that: “Substantial savings could be realized by insurance carriers and employers, and the nurse shortage could be eased, if workers’ comp carriers assisted employers to retain back-injured nurses in other non-lifting nursing positions.”
Her comment led us to the Working Injured Nurses Group or WING USA, a site that provides information, advice, and support to injured nurses. Anne is a founder of this group as well as co-author of Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts. She has been active in championing the cause of back-injured nurses – both in terms of prevention and also in advocating for reemployment of injured nurses in positions that don’t require lifting.
We appreciate informed comments from our readers. If you have resources, information, or just opinions, we encourage you to jump in!

Washington passes “Safe Patient Handling” legislation

Thursday, March 23rd, 2006

Few think of health care as one of the nation’s most hazardous professions, but there you have it: nurses, nursing home attendants, and other health care workers are among the nation’s most frequently injured work population, suffering from a high incidence of musculoskeletal injuries. Patient care calls for frequent lifting and moving, and this wreaks havoc with the back and shoulders. It’s estimated that as many as 12 to 18% of all nurses stop practicing due to chronic back pain. The nursing shortage means that many health care workers have to do more with less, increasing the likelihood of injury; ironically, these injuries may be a primary culprit in exacerbating the nursing shortage.
Not to mention the hazards to the patient. When you are at your most vulnerable, do you really want a single nurse to be heaving you about? Bill Cosby used to have a stand-up routine about how you never wanted to hear a doctor say “oops.” Similarly, When you are taking your first steps after major surgery, you don’t really want the nurse who is helping you to say “ouch” – a helper who is writhing in pain may not be in your best interests.
Legislators in Washington – prompted by the Washington State Nurses Association, United Food and Commercial Workers Local 141 and Service Employees International Union 1199NW – just passed a Safe Patient Handling law that requires hospitals to provide mechanical lift equipment for the safe lifting and movement of patients. According to Occupational Hazards:

“On a timeline between Feb. 1, 2007, and Jan. 30, 2010, Washington hospitals must take measures including implementation of a safe patient handling policy and acquisition of their choice of either one readily available lift per acute-care unit on the same floor, one lift for every 10 acute-care inpatient beds or lift equipment for use by specially trained lift teams.”

In August, we reported on Texas legislation that required nursing homes and hospitals to implement safe patient handling and movement programs. Most importantly, both laws have provisions that protect health care workers from reprisals should they refuse to perform patient handling that they deem potentially harmful to themselves or their patients.

Texas enacts safe lifting guidelines for a hazardous industry

Tuesday, June 28th, 2005

Quick – name the three leading industries with the overall greatest numbers of injuries and illnesses.
I’ve run this little pop quiz on people who work in the industry and those who don’t, and it’s rare that people get the right answers. According to Bureau of Labor Statistics, the dubious *winners* in the win, place, and show categories are laborers and material movers; heavy and tractor-trailer truck drivers; and nursing aides, orderlies, and attendants. (source)
For many people, this information is something like a game my nieces used to play called “one of these things is not like the other.” Many are startled to learn that our nation’s healthcare workers are right up there in the ranks of the nation’s most hazardous professions. The reason is largely due to patient handling that takes a heavy toll in back and neck injuries. An article in ErgoWeb describes some of the hazards for nursing home staff.
“In “Ergonomics: Guidelines for Nursing Homes,” OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn’t difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer’s disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.
Some good news from Texas
From Jordan Barab’s Confined Space, we learn that Texas has taken legislative steps to protect healthcare worker safety. The state is the first to enact legislation (TX SB 1525) requiring hospitals and nursing homes to implement a safe patient handling and movement program. The legislation takes effect on January 1, 2006. In his post, Jordan notes:
Most significantly, the law requires the plan to include “procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury.”
This is good news for healthcare workers and hopefully other states will follow suit since OSHA has issued only ergonomic guidelines which, although good for what they are, many feel are meaningless in terms of affording workers any protection.

Morbid Obesity: One Man’s Tale

Monday, June 27th, 2005

David Montgomery, a staff writer for the Washington Post, has written a moving and intimate article (registration required) about John Keitz, who weighs 625 pounds (down from his maximum weight of 781 pounds). The article is accompanied by a remarkable set of photographs, which you should be able to link to at the article. Keitz is so heavy his legs will not support his weight. The last time he stood on his feet was Aug. 1, 1998. That night he was making macaroni and cheese for his wife, Gina. He boiled and drained the noodles. Right after he cut in the Velveeta (nutritionists take note), he went down — and he has been bedridden ever since. Keitz is 39 years old. This article presents Keitz as a man of Falstaffian dimensions, who regales the reporter with his exploits as a youth and dreams of the day when he can sit up and even stand up on his own.
Morbid Obesity Personified
Keitz has to lie on his front, because if he were to lie on his back, rolls of flesh would press on his windpipe and suffocate him. His head never touches sheet or pillow. At night, his left cheek nestles upon a soft white pile of shoulder and breast meat.
Every time Keitz must be moved — usually to the hospital to treat his asthma — a major public drama ensues. One time, firefighters removed two windows from his second-story apartment and extracted him with a lift truck. More recently, firefighters used a whale sling from the National Aquarium in Baltimore to haul him out of his house in Dundalk. They put him on a flatbed truck. His ordeal was rehashed on late-night television and morning radio.
Obesity as Illness
At 26, Keitz got the first dramatic warning that his weight was barreling out of control. On the job at a bowling alley, his knees gave out. Doctors diagnosed severe arthritis. He stopped working regularly and began receiving disability checks. I think we can assume that the disability payments were under SSDI and not workers comp.
Montgomery writes that many scientists, doctors and health insurance executives are coming around to the conviction that obesity is a disease. But it is a disease with personal responsibility attached. Advocates for obese people say health care is full of conditions that involve personal choice: smoking; alcoholism; gum disease brought on by poor dental hygiene; skin cancer following too much tanning. Yet obesity is unique in how much blame is placed on the victims themselves. “Once you take off this moral interpretation, it is a dysfunction of the body and an abnormal physiological state,” says Morgan Downey, executive director of the American Obesity Association in Washington.
Workers Comp Risks
I would direct you to the 6th image in the gallery of photos that accompanies the article. (It is sometimes difficult to access Washington Post articles, so I will describe the scene in detail.) Six men from East Coast Ambulance surround Keitz. They have placed a yellow rubber tarp under him. On the count of three, they all lift. You can see the strain on the face of one of the men near to the camera — the faces of the others are obscured in the dim light of the dingy apartment. The men have only the yellow tarp to hold — there are no handles, so the lift places tremendous pressure on their forearms, fingers and wrists. Four of the men are clustered around Keitz’s formidable upper body, so only two are available to lift his lower body. Theoretically, it’s a 105 pound lift for each man. However, Keitz’s great bulk is prone to shifting, so the weight itself may change as they head for the ambulance. Indeed, you can tell from the photo that some of the men bear more weight than others (at least one appears to be “dogging” it). Ergonomically, the lift is far from ideal. Beyond that, there is clutter on the floor — tripping hazards for the men as they begin to move Keitz toward the door. There is no stretcher or gurney in the photo — it appears that they are going to carry him out of the house to the waiting ambulance.
The doorway is of average width. How will the men get through it, when Keitz’s bulk alone will barely fit through? The men at his head will have to squeeze ahead, while trying to keep Keitz from slipping out of the sling. We are left with no answers, as this is the only photo of this particular move. Given the absence of additional details in what is a very comprehensive article, perhaps we can assume that the lift was performed without any problems. No workers comp claims this time. (One hospital client of ours had two serious back injuries in the single lift from an ambulance of a similarly sized person.)
Heavy Issues
Obesity is surely a personal crisis for those who suffer from it, as well as for those who love them. It presents challenges to employers. It is also a crisis for the insurance industry — to pay or not to pay for stomach stapling, that is the question — see this Los Angeles Times article. On the front lines, it’s a huge challenge for health care workers who are called upon to move morbidly obese individuals under very difficult conditions. In the working world, it’s not always possible to perform the work as outlined in the ergonomic textbooks. All too often the workers — and their employers — are left to bear the consequences.

The Smallpox Conundrum

Friday, January 28th, 2005

Remember smallpox? At the height of concerns about terrorism following 9/11, the federal government proposed that health care providers and first responders get vaccinated against the disease. The lack of response, as they say, was deafening. Recently there was a privately-funded simulation of a smallpox incident in the news. Headed up by former Secretary of State Madeline Albright, the exercise — dubbed “Atlantic Storm” — posed a scenario in which terrorists spread dried smallpox at an airport in Frankfurt, Germany and a number of other locations throughout Europe and the United States. The simulation revealed a number of serious weaknesses in our current planning. As the former Polish Prime Minister, Jerzy Buzek, put it: “Fortunately, we are not prime ministers anymore. Nobody is ready.”
Here are a few facts concerning the vaccination for smallpox (for detailed information, see the CDC’s website):

  • For the most part, the vaccination is safe: the rate of adverse response to the vaccine is relatively small (1,000 serious reactions for every million vaccinated). However, given the scale of the anticipated inoculations that would be needed if all health care providers needed protection, there is cause for concern. Under rare circumstances the vaccine can lead to death.
  • After vaccination, the individual is potentially contagious, for up to three weeks (as long as the vaccination site remains open). This means that health care workers — primary targets for vaccination — might not be able to work for a significant period of time.
  • There is a portion of the general population that is at higher risk for adverse reaction to the vaccine (e.g., people with a history of eczema or acne, HIV positive individuals, burn victims, cancer patients, pregnant women). There are guidelines for screening these individuals out of a vaccination program.

The Public Policy conundrum
The smallpox vaccination program raises a number of issues involving workers compensation and other forms of insurance. In addition, there are some gray areas, where vaccinated workers and their families may face periods of disability that are not covered by insurance. Here is our take on just a few of these issues:
If employers require their employees to be vaccinated, any adverse responses would certainly be covered by workers comp, up to and including death. Even if the vaccination is “voluntary,” adverse reactions are still likely to be covered by workers comp. There is a potential “disproportionate impact” on insurers of health care facilities and ambulance services, whose workers are first in line for vaccination. This exposure is not currently contemplated in workers comp rates.
Regarding the significant portion of the general population that is at higher risk for adverse reaction to the vaccine (see above), many of these vulnerable individuals work in health care facilities, where their not being vaccinated might put them at higher risk for serious illness. If exposed to smallpox, they would be at very high risk when they are compelled to take the vaccine to stave off the illness.
As if the real risks were not enough, the considerable publicity about the dangers of the vaccine significantly increases the probability of “false positives” — people reporting what may be imaginary ailments. These “false positives” would immediately appear on the workers comp radar screen.
Here’s the crux of the problem for the health care industry: inoculated workers might not be allowed to come into contact with patients during their potentially contagious period (up to 21 days). This would apply especially to health care workers whose patients include the highly vulnerable groups mentioned above. This inability to work is not a period of “disability” but of quarantine. Workers comp would not apply. Who replaces the lost wages during this period? Is it fair to require workers to use their sick leave? What if they do not have any sick leave? Beyond that, if there is a mass inoculation of health care workers, how will hospitals staff their facilities during the quarantine period?
As if all the above weren’t enough to worry about, during the contagious period, a worker might infect family members. How would these exposures be covered?
This is not meant as a definitive summary of the smallpox policy issues. However, it is clear that any mass inoculation program will raise a number of concerns that need to be confronted head on, not as we are currently doing, with our heads buried in the sand.

NIOSH issues alert for healthcare workers who are exposed to hazardous pharmaceuticals

Friday, June 11th, 2004

If you asked the average “man on the street” to name dangerous professions, chances are nursing and other healthcare professions wouldn’t make the list. Yet according to the Bureau of Labor Statistics, hospitals have the second highest rate of nonfatal injury or illness cases. Many of the risks are well known: back injuries and musculo-skeletal disorders from lifting patients; exposure to blood-borne pathogens; and injuries resulting from assault by patients.

Somewhat less obvious are the risks posed by exposure to hazardous drugs. Recently, NIOSH released a lengthy alert about chemotherapeutics and other drugs. As many as 5.5 million healthcare workers — including nurses, pharmacists, physicians, and veterinarians — are exposed to antineoplastic and other hazardous drugs in the course of their work:

“Healthcare workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in air or on work surfaces, contaminated clothing, medical equipment, patient excreta, or other sources. Studies have associated workplace exposures to hazardous drugs with health effects such as skin rashes and adverse reproductive events (including infertility, spontaneous abortions or congenital malformations) and possibly leukemia and other cancers. The health risk is influenced by the extent of the exposure and the potency and toxicity of the hazardous drug. Potential health effects can be minimized through sound procedures for handling hazardous drugs, engineering controls and proper use of protective equipment to protect workers to the greatest degree possible.”

The NIOSH alert is a “prepublication” report that will undergo further editing before a final release sometime this year. The final report will present a voluntary guideline that will include information on more than 100 drugs and will offer detailed recommendations for control measures that should be taken by employers and employees to reduce risks. Many measures assumed to be adequate in the past may not be sufficient protection in response to the risk.

In an article in entitled Do more to protect health workers from chemo agents that appeared in Hospital Employee Health, Thomas Connor, PhD, a research biologist with NIOSH in Cincinnati and an author of the alert indicated that workers may not be aware of the risk:

“Exposure may occur in these situations: Drugs are reconstituted or diluted. Nurses or others expel air from syringes or give injections, and small amounts are aerosolized. Uncoated tablets are counted or dosed in a unit-dose machine. Health care workers touch contaminated surfaces, patients’ body fluids, or contaminated clothing and linens. Workers prime the IV with drug-containing solution or administer the drug with the IV.

Every step along the way, you have the potential for release and exposing the workers, says Connor. I don’t think people are aware of it. They can’t see it [because the drugs are colorless] and don’t think there can be a spill.”

Requests for printed copies when they become available can be made through the NIOSH toll-free information number, 1-800-35-NIOSH, or by contacting the NIOSH Publications Office through the NIOSH web page.