Literature Reviews
Literature Reviews
Fragala G. Ergonomics: How to Contain On-the-Job Injuries in Health Care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1996.
The author, an occupational health and safety expert, health care ergonomics consultant, and director of environmental health and safety at the University of Massachusetts Medical Center in Worcester, describes a comprehensive ergonomics program that meets the expectations of both the Joint Commission on Accreditation of Healthcare Organizations and the U.S. Occupational Safety and Health Administration. The book’s approach focuses on problem-solving and is tailored to the particular needs of hospitals and nursing homes, making it a valuable and rare resource for the employee health practitioner.
In the first section of the 151-page book, Fragala creates a fictional health care organization called Metro East, and establishes a scenario in which a group of upper-level managers "undertake to learn how they can turn around an occupational injury problem that is in every way typical of the norm," the section’s introduction states. "In their attitudes and concerns . . . the characters in this scenario are typical of their real-life peers, gathered in similar conference rooms in hospitals and nursing homes all across the country right now. They have doubts, they have budgets, they have blind spots."
Within this framework, Fragala presents a thorough discussion of the causes and consequences of musculoskeletal injury, including the magnitude of the problem among health care workers, lessons learned from past prevention efforts, the theory and practice of ergonomics programs, the nature of occupational disorders of the musculoskeletal system, and risk factors for those disorders.
Model program takes five-step approach
Section II focuses on the science of ergonomics, which Fragala describes as "designing jobs and job tasks to meet the physical limitations of the work force." He presents a model ergonomics program that takes a five-step approach to development and implementation similar to other kinds of organizational problem-solving: problem identification, problem analysis, formulation of recommendations, implementation, and evaluation. Chapters in this section cover OSHA’s draft proposal for an ergonomics standard; the Joint Commission’s framework for improving performance; identifying, assessing, and analyzing risk; formulating ergonomics recommendations, including engineering and administrative controls; implementing recommendations, including awareness campaigns and employee training; and measuring and assessing a program’s impact.
The book also contains an index and several appendices. The latter include guidelines for medical management of cumulative trauma disorders, a summary report of recommendations on workstation design, guidelines for workstation design, and research findings on body mechanics training.
Each chapter is packed with useful statistics, tables and other graphics, sample forms, worksheets, data collection and reporting instructions, case studies, and other valuable information for hospital employee health practitioners whose responsibilities include reducing and managing musculoskeletal injuries. The book is a resource guide that presents a workable plan for introducing sound ergonomics principles into the hospital workplace. t
Ippolito G, Puro V, Petrosillo N, et al. Prevention, Management & Chemoprophylaxis of Occupational Exposure to HIV. Charlottesville, VA: International Health Care Worker Safety Center; 1997.
This new 94-page book, dedicated to "health care workers worldwide infected by HIV in the course of caring for others," is written by international experts on occupational HIV risks and treatments, infection control, infectious diseases, and HCW safety.
With five extensively referenced sections; three appendices of forms for reporting sharp-object injuries, blood and body fluid exposures, and post-exposure follow-up, as well as an illustrated list of needle safety devices; and 13 information-packed tables and figures, the book likely will become the standard desktop reference on the subject of HIV post-exposure prophylaxis for occupationally exposed HCWs. This is a thorough, easy-to-use guide that belongs in every hospital employee health department.
As the introduction states, the book provides "an update of important information for hospital employee health professionals and medical staff responsible for the prevention and management of occupational exposure to HIV." In light of recent recommendations from the federal Centers for Disease Control and Prevention regarding new prophylactic drug regimens as part of post-exposure follow-up (see related story in Hospital Employee Health, August 1996, pp. 85-92), the book offers a timely discussion of the data supporting those recommendations, in addition to guidelines for their implementation.
Part 1 of the book presents background information relating to HIV occurrence and course of infection. In Part 2, the authors focus on bloodborne pathogens in the health care setting, with information on prevalence, HIV in the patient population, types of exposures, and HIV transmission rates and risks (including mention of recent evidence that HIV and other bloodborne pathogens are transmitted efficiently through blood exposures of the conjunctivae).
Study found 96% underreporting rate
Rates and causes of occupational blood exposures in hospitals are discussed in Part 3. Job-specific percutaneous injury rates are given, and the subject of underreporting is explored. One study found that as few as one out of 25 adverse blood exposures observed in the operating room was reported to the employee health department, a 96% underreporting rate. Also included in this section is information compiled from the Exposure Prevention Information Network surveillance system used by about 1,500 U.S. hospitals and in eight foreign countries.
Part 4 focuses on HIV exposure management, including recommendations for post-exposure prophylaxis. The information includes first aid, the need for 24-hour emergency counseling and advice, antiretroviral chemoprophylaxis, and follow-up. Detailed information is presented regarding transmission risk assessment; exposure evaluation; testing, follow-up, and counseling; the rationale for post-exposure chemoprophylaxis (including efficacy and safety data); CDC recommendations; pre-exposure counseling for post-exposure prophylaxis; and recommended measures for health care institutions.
Prevention of occupational blood exposures is discussed in Part 5, with a review of the bloodborne pathogens standard, means of preventing contact with at-risk body substances, sharps disposal systems, and safer devices and practices (including recommendations for safer blood drawing due to high rates of pathogens transmission associated with blood-drawing equipment and intravenous catheters).
The section ends with the following statement: "We have a long way to go beyond Universal Precautions in order to achieve the level of prevention that we are capable of, and that health care workers need and deserve." t
Pugliese G, Tapper ML. Tuberculosis control in health care. Infect Control Hosp Epidemiol 1996; 17:819-827.
The authors describe a basic tuberculosis control program, including assessing TB risks, prioritizing control methods based on effectiveness, and meeting regulatory requirements. They also discuss problematic issues, present examples of how hospitals have confronted them, and suggest sources of additional information about nosocomial TB.
Because the federal Centers for Disease Control and Prevention report that 42% of U.S. counties have not reported any TB cases in the past year, and another 47% have reported fewer than nine cases, the article focuses on minimal-risk and very-low-risk facilities.
First steps include assembling a task force for developing a TB control program, evaluating its effectiveness, and correcting deficiencies. "One size does not fit all when it comes to TB control measures," the authors state. Therefore, practitioners must assess TB transmission risks in their particular institutions according to CDC guidelines. Information about a community’s TB profile can be obtained from local or state health departments, extended-care facilities, schools, homeless shelters, or prisons. Even if no TB cases have been reported in a community, epidemiology staff still should determine if patients with TB were admitted or treated in the hospital. Using the acquired information, practitioners would establish their facility’s risk assessment.
Next, specific control measures must be prioritized. This "hierarchy of controls" separates measures into administrative controls, engineering controls, and respiratory protection. Administrative controls are to be implemented first, and include developing and implementing effective policies and protocols to identify TB patients rapidly, isolate them properly, evaluate them clinically, and treat them appropriately.
Employees also must be educated, trained, and counseled about TB, and screened for TB infection and disease. A section on employee skin-testing describes the standard method, determining who is considered an employee, frequency of testing, calculating and interpreting conversion rates, two-step baseline testing, and methods of improving compliance.
Engineering controls include local exhaust ventilation, general or central ventilation, air filtration with high-efficiency particulate air filters, and air disinfection with ultraviolet germicidal irradiation, all designed to remove droplet nuclei from the air. The article discusses each option.
The discussion of respiratory protection, the last step of the hierarchy of controls, includes regulatory considerations, fit-testing, and levels of respirator protection.
"Until OSHA develops a specific TB standard, it recognizes the CDC’s TB guidelines as the accepted standards of practice, and it enforces compliance with the key components of the CDC guidelines," the authors point out. Noncompliance with requirements can result in fines of up to $70,000 per violation, they note. A useful table summarizes OSHA’s required elements for TB control in health care facilities.
Enter American Health Consultants’ on-line CE program and earn ANA-certified CE via the Internet. Save time and money by taking CE tests in areas such as infection control, hospital employee health, case management, quality assurance, patient education, and more. Your test will be graded on-line and your certificate delivered by e-mail immediately upon passing. Three secure payment options are available. Price: $15 for 1.5 hours of ANA CE credit. Log on at http://www.ce-web.com.
Stopping Workplace Violence in Healthcare and Social Services is a 16-page illustrated booklet designed to give employees practical information on how to handle and prevent violent situations. Written in a straightforward, conversational style, it can be distributed at training sessions, in lunchrooms, on literature racks, or as envelope stuffers. A free examination copy is available. Contact: Business & Legal Reports, 39 Academy St., Madison, CT 06443-1513. Telephone: (800) 727-5257. Fax: (203) 245-2559.
Health Fairs for Your Wealthfare is a sourcebook containing checklists, charts, and practical information to help organize employee health fairs, which usually are scheduled in the spring. Cost is $30, with discounts for members of the Wellness Councils of America (WELCOA). Contact: WELCOA, 7101 Newport Ave., Suite 311, Omaha, NE 68152. Telephone: (402) 572-3590. Fax: (402) 572-3594.
The 1997 Healthcare Standards Directory includes specific technical standards, clinical practice guidelines, position statements, and federal and state regulations. Purchasers also receive an unlimited number of free searches of the Healthcare Standards database, which is updated daily, and a quarterly newsletter that keeps purchasers informed of new or revised standards. Cost is $365. Contact ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Telephone: (610) 825-6000. Fax: (610) 834-1275.
MCS Referral & Resources offers a comprehensive bibliography of more than 300 peer-reviewed journal articles on multiple chemical sensitivity, more than half published since 1992. The cost is $50. A detailed, fully referenced list of legislative and administrative policies and court decisions that recognize MCS as a legitimate disease and/or disability also is available for $40 per issue or $200 per year (six issues). Contact MCS Referral & Resources, 508 Westgate Road, Baltimore, MD 21229-2343. Telephone: (410) 448-3319. Fax: (410) 448-3317.
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