Back belts don’t support injury prevention

Editor:

Abdominal belts, like all off-the-shelf splints, are non-regulated medical devices. [See related story in Hospital Employee Health, September 1996, pp. 97-103.] This fact, however, makes their use neither trite nor without potential adverse side effects. They are being actively promoted by suppliers as a panacea and adopted by employers as a quick fix. There is no — underline no! — single scientifically conducted study that advocates their universal adoption. There are indications for individual usage, on the recommendation of a health practitioner, after careful consideration of all the appropriate parameters pertaining to the workstation and the employee’s health status.

I neither advocate nor endorse the casual, indiscriminate, and universal provision of abdominal belts, nor of braces or splints of any kind. Medical devices should not be offered nor provided without prior consultation with, and approval by, the employer’s occupational health service.

Common, proven side-effects of back belts are:

• increased blood pressure by up to 15 mm Hg;

• muscle wasting;

• false sense of security;

• dependency on the belts with increased injury rates following their discontinuance, as compared to controls;

• an actual magnification of workload forces by poorly fitted and inappropriate belts;

• a Band-Aid solution that deceivingly obviates a more systematic search for underlying causes and precludes implementation of definitive solutions.

Back pain is a physiologic phenomenon amenable to medical treatment. Control of the rate of incidence and of the degree of disability, however, rests outside the scope of the disease model. Incidence is best approached via training, engineering solutions, and administrative controls, and severity or disability by critically considering a multitude of psychosocial factors such as job satisfaction, management-labor relations, previous absenteeism, (non)availability of modified duties, benefits entitlement, staffing, the aging work force, task demands, etc.

A litany of articles and papers has been written on the back pain problem. The consensus is that the effective solution comprises management commitment to health and safety, applied ergonomic principles, and consistent administrative controls. Seductive minor interface enhancements will not address, much less solve, fundamental problems.

Gabor Lantos, MD, MBA, PEng

Occupational Physician

Occupational Health Management Services

Toronto, Ontario, Canada

Jagger J. Reducing occupational exposure to bloodborne pathogens: Where do we stand a decade later? (Editorial) Infect Control Hosp Epidemiol 1996; 17:573-575.

The author, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville and member of the Hospital Employee Health editorial advisory board, reviews efforts to protect health care workers from bloodborne pathogens exposures during the 10 years since the process of implementing the federal bloodborne pathogens standard began.

Important advances in creating a safer health care setting include safer sharps disposal systems, safer workplace practices (less needle recapping, less hand contact with blood, increased use of personal protective equipment), more barrier products with greater fluid resistance and improved design, and safer needle devices and sharp instruments.

"Since 1984, more than 1,000 patents have been issued for devices designed to prevent needlesticks," the author notes. While acceptance of the new technology varies among hospitals, most U.S. HCWs have evaluated at least one of the new safety devices. Needleless or protected-needle intravenous systems are the most widely used; more than 50% of U.S. hospitals have converted to those systems from hypodermic needle connections for piggybacks and intermittent IVs.

A major remaining obstacle to more effective protection of HCWs from blood exposures is documenting the impact of changes. The difficulty lies in the shortage of "old data" that can be compared to more recent data on causes of needlestick injuries.

Jagger says strong evidence does exist that recapping as a cause of needlesticks, first described in 1981, recently has declined significantly. A 1986 study showed that one-third of needlesticks from hollow-bore needles occurred during recapping, but in 1994 and 1995, only 4% of needlesticks from hollow-bore needles were due to recapping. Reasons for the difference are unclear, as are the questions of whether a reduction of recapping-related needlesticks implies an overall decrease in needlesticks, or whether HCWs are injured more frequently by exposed needles.

Additional 1986 study data suggest that the injury rate from IV catheter stylets at one hospital was 18.4 per 100,000 catheters purchased. In 1992, a safety catheter with a retractable shielded stylet was introduced into that and two other hospitals in the Exposure Prevention Information Network (EPINet) run by Jagger’s program. After 12 months of using the safety catheter and the same brand of conventional catheter, overall injury rates were compared. The rate for the conventional catheter was 7.5 per 100,000 purchased, while the rate for the safety catheter was 1.2 per 100,000 purchased, representing an 84% reduction.

The data suggest that although education and improved disposal systems can reduce injury rates when conventional devices are used, "an effective safety device potentially can reduce injury rates far more than can be accomplished by education and good disposal systems alone," Jagger states.

Despite the progress of the last decade, discovering what works to prevent percutaneous exposures will take time. Facts to keep in mind during the process include:

• A "honeymoon phenomenon" is associated with new devices, but enthusiasm must be followed by a more practical, critical assessment.

• Because new safety devices are scrutinized more than the products they replace, more problems are likely to be found.

• Needlesticks are rare events from a statistical perspective, so the more they are prevented from occurring, the longer it will take — and the more difficult it will be — to prove the efficacy of safer needle devices.