HEH at a crossroads: Hospital hazards come to the forefront

Health and safety become tools for recruitment, retention

Twenty-five years ago, hospitals didn't have safe needle devices or mechanical lifts. Employees weren't routinely required to have the rubella or measles vaccine. A new "mystery illness," which would later be identified as AIDS, created fear among health care workers, and hospitals were trying to define the role of the employee health nurse to address work hazards.

As Hospital Employee Health publishes its 25th anniversary issue, employee health professionals can take pride in their accomplishments, such as dramatic reductions in needlestick injuries. Yet challenges remain and hospitals continue to be high-hazard workplaces, with more injuries and illnesses than in construction and transportation.

"I don't think hospitals saw themselves as a hazardous industry. Their focus was on the patients," says Kathy Harben, the first editor of HEH who now is an enterprise communication officer for the Centers for Disease Control and Prevention Coordinating Office for Global Health.

But professionals in infection control and risk management had begun to grasp the link between patient safety and employee safety: The hospital had to be safe for both. "They were seeing trends that this was going to be an important new area for hospitals to pay attention to," she says.

HEH reflected the needs of employee health professionals and their new organization, the Association for Hospital Employee Professionals (now called the Association of Occupational Health Professionals in Healthcare, or AOHP).

The first issue, in January 1982, reported on the new hepatitis B vaccine. It also outlined the minimal requirements that existed for hospital employee health: The Joint Commission on Accreditation of Hospitals (now called the Joint Commission on Accreditation of Healthcare Organizations) said a hospital's CEO should "determine the scope of the employee health program." Twenty-six states had no regulations governing hospital employee health, including immunizations of health care workers, and there were no federal standards directed at hospital-specific hazards.

Today, hospital employee health functions in a more regulated environment. Since 1981, there have been a total of 6,058 inspections in hospitals, resulting in 16,496 citations. As some hospitals became unionized, complaint-based inspections rose. In fiscal year 1982, the U.S. Occupational Safety and Health Administration (OSHA) conducted just 84 inspections in hospitals; in FY 2006, there were 165 inspections. Hospitals are among the high-hazard workplaces that may receive a targeted, wall-to-wall inspection if they have high injury rates.

Yet most hospitals never receive a visit from an OSHA inspector. The role of employee health goes far beyond meeting regulations; it's up to employee health professionals to communicate their value to hospital administration, says MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, employee health coordinator at Western Pennsylvania Hospital (West Penn) in Pittsburgh and past executive president of AOHP.

"Most of us don't have the human resources we need to provide programs and services the way we would like to," she says. "So you do have to prioritize and you do have to pick your battles."

'One of most dangerous industries'

Although injuries and illnesses have declined, hospital employees still face significant hazards. The earliest data available on workplace injuries and illnesses show in 1993 that hospitals had a rate of 11.8 lost-time injuries per 100 full-time (FTE) equivalent workers, according to the Bureau of Labor Statistics. In 2005, there were 8.1 injuries and illnesses per 100 FTEs.

Most Common Lost
Workday Injuries

1992
1. Overexertion in lifting
2. Fall on same level
3. Struck by object
4. Exposure to harmful substance or environment

2005
1. Overexertion in lifting
2. Fall on same level
3. Struck by object
4. Exposure to harmful substance or environment

Source: Bureau of Labor Statistics, http://stats.bls.gov.

Throughout those years, overexertion in lifting has remained the primary cause of injury for hospital employees.

William Charney, DOH, was one of the first to press for ergonomic solutions to address back injuries in nursing. As director of safety for Jewish General Hospital in Montreal — the first safety officer at a hospital in Canada — Charney applied principles that were more common in industrial workplaces.

"[Health care] was one of the most dangerous industries in the United States and Canada, but it wasn't on anyone's radar screen," recalls Charney, now a national consultant based in Seattle. "There was a lot of work to be done, and there was very little research in the field."

A 1972 survey by the National Institute for Occupational Safety and Health (NIOSH) found that only 35% of small hospitals had regular safety and health education programs, and only 39% of all hospitals had immunization programs for health care workers.1

Awareness began to build not only of the risk to hospital workers, but the cost of injuries and illnesses. In its 1988 Guidelines for Protecting the Safety and Health of Health Care Workers, the agency noted: "Compared with the total civilian work force, hospital workers have a greater percentage of workers' compensation claims for sprains and strains, infectious and parasitic diseases, dermatitis, hepatitis, mental disorders, eye diseases, influenza, and toxic hepatitis."1

Health care workers' unions and advocacy groups such as Public Citizen pressed for changes. They filed petitions with federal agencies, complaints with OSHA, and lawsuits.

"In 1976, NIOSH came out with a study saying the average hospital had twice as many chemicals as the average manufacturing facility. I was struck by that," recalls Bill Borwegen, MPH, occupational safety and health director for the Service Employees International Union (SEIU). "When I delved deeper, I realized that nurses' aides had the highest rate of back injuries of any occupation and nurses weren't far behind.

"All of that was exacerbated by the stress of working in an understaffed environment, which wasn't much different than it is today," he says.

Gaining recognition for employee health

The opportunity for improving employee health and safety has never been greater. With a nursing shortage and the aging of the nursing work force, hospitals increasingly recognize employee health as a tool for recruitment and retention.

Threats such as SARS and the potential for pandemic influenza highlight not only the risks to health care workers but the need to maintain an adequate work force.

"There's been increasing recognition, for a number of reasons, of the specific complexities of medical center worksites," says Mark Russi, MD, MPH, director of occupational health at Yale-New Haven (CT) Hospital and vice-chair of the Medical Center Occupational Health section of the American College of Occupational and Environmental Medicine. "I think people understand that there is a specific expertise that needs to be acquired to properly address the occupational medicine of health care workers."

AOHP now has a formal alliance with OSHA and a memorandum of understanding with NIOSH, evidence of the higher profile of hospital employee health. Employee health professionals need to keep on top of legislative and regulatory issues as well as CDC guidelines, and they need to provide that information as well as specific hospital data to administrators, says Gruden.

You can leverage your limited resources by tapping into other expertise within the hospital and forming interdisciplinary teams to tackle health and safety problems, she adds. "There's a lot of opportunity to become recognized within your organization," she says.

Reference

1. National Institute for Occupational Safety and Health. Guidelines for Protecting the Safety and Health of Health Care Workers DHHS (NIOSH) 88-119. Washington, DC; 1988.



A Timeline of
Employee Health

April 1971: The U.S. Occupational Health and Safety Administration (OSHA) and the National Institute for Occupational Safety and Health begin workplace injury
prevention efforts.

January 1981: A group of employee health nurses meet to form the Association of Hospital Employee Health Professionals, which later becomes the Association of Occupational Health Professionals in Healthcare (AOHP).

January 1982: Hospital Employee Health newsletter publishes its first issue, highlighting the new
hepatitis B vaccine.

April 1982: HEH reports on a threat from a "mystery illness," which would later be identified
as AIDS.

August 1983: HEH reports the first cases of occupationally acquired AIDS in health care workers.

July 1984: The Advisory Committee on Immunization Practices (APIC), an advisory panel to the Centers for Disease Control and Prevention (CDC), recommends the influenza vaccine for health care workers.

December 1989: HEH publishes its first salary survey. The average salary for an employee health director/coordinator is $35,384.

December 1990: The CDC recommends the use of "particulate respirators" to protect health care workers from tuberculosis.

March 1991: The Food and Drug Administration publishes an alert on the hazard of latex allergy sensitivity among health care workers.

December 1991: OSHA issues the bloodborne pathogen standard requiring the use of safer needles.

July 1997: The nation's first ergonomics standard becomes effective in California.

September 1997: NIOSH warns health care workers about latex exposure.

September 1998: California sets a precedent with a law requiring hospitals to use safe needle devices.

November 2000: President Clinton signs the Needlestick Safety and Prevention Act.

November 2000: OSHA issues a comprehensive ergonomics standard requiring the assessment and abatement of hazards.

March 2001: Congress rescinds the ergonomics standard.

November 2002: The SARS outbreak begins in China. As the epidemic progresses, health care workers account for a third to half of cases in outbreak countries.

January 2003: Health care workers begin receiving the smallpox vaccine as part of bioterrorism preparedness.

December 2003: OSHA withdraws its proposed TB standard. Hospitals must now comply with the annual fit-testing requirement in the respiratory protection standard.

December 2003: The current outbreaks of avian influenza (H5N1) begin. Within three years, 256 cases and 152 deaths have been linked to avian flu.

November 2005: The U.S. Department of Health and Human Services issues its Pandemic Influenza Plan.

November 2006: An HEH salary survey reveals that 48% of employee health professionals earn from $50,000 to $69,999.



Reflections on 25 years of Hospital Employee Health

"HEH gave us a voice. [The newsletter] gave a cohesiveness to what we were doing and helped to set the standards of practice." — Joyce Safian, RN, FNP, PhD, the first executive president of the Association of Occupational Health Professionals in Healthcare, or AOHP (then called the Association for Hospital Employee Professionals).

"The role has evolved into something that's very comprehensive. You need to be able to communicate what value you can bring to the organization, because no one else is going to do it for you." — MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, employee health coordinator at Western Pennsylvania Hospital (West Penn) in Pittsburgh, past executive president of AOHP, and board member of HEH.

"I think there has been renewed attention to health care worker safety in the wake of Sept. 11 and the emergence of diseases such as SARS and H5N1 influenza. It's a field that has moved to the front burner." — Mark Russi, MD, MPH, director of occupational health at Yale-New Haven (CT) Hospital and vice-chair of the Medical Center Occupational Health section of the American College of Occupational and Environmental Medicine.