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Sharps injury risk higher in home health
Focus groups reveal hazards in homes
Home health nurses face a substantial risk of sharps injuries but often do not get prompt follow-up, according to a study by researchers at the University of Massachusetts Lowell.1
In focus groups and interviews, nurses also told of exposed sharps in their patients' homes, a lack of safety-engineered devices, and sharps containers that overturn and spill in their cars. The study highlights the need to tailor sharps injury prevention to home health care needs, says study co-author Stephanie M. Chalupka, EdD, APRN, BC, CNS, FAAOHN, professor in the Department of Nursing in the School of Health and Environment at the university.
"In the hospitals, it's very rare, and people frown on people leaving improperly disposed of sharps around. In the home care setting, insulin-dependent diabetics are going to leave their equipment around in places that nurses may not expect to encounter it," says Chalupka. "There are frequently used devices left unsheathed until the next use. When you're on a fixed income, in an effort to be economical, you may say, 'I can use this until the needle gets dull.'"
Meanwhile, patients being treated in the home have an increasingly high acuity. "More and more demanding medical procedures are moving into the home setting," says co-author Pia Markkanen, ScD, research assistant professor at the Department of Work Environment and Lowell Center for Sustain-able Production at the University of Massachusetts Lowell.
In all, 17 nurses and seven home health aides participated in five 90-minute focus groups. They were recruited from participating home health agencies and worker unions. The researchers also conducted 10 in-depth interviews with managers and union representatives.
Many of the nurses, aides, and managers had experience in the hospital setting, and they noted that hospitals provided a more supportive environment for reporting and follow-up of bloodborne pathogen exposures.
Home health nurses 'working in isolation'
The home health nurses lack backup, notes Chalupka. "[Home health] nurses are working in isolation. They are the only person caring for that patient," she says. They are reluctant to seek care for their needlestick if there is no other nurse or aide who can take over for them, she says. Meanwhile, the closest health care facility may be many miles away, Chalupka adds.
In fact, the isolation of home health workers also makes their workplace hazards less visible, the authors conclude. Meanwhile, the home health workers are dedicated to patient care and report that they enjoy the independence of the job. "In some ways, people we have spoken to take it just as part of the job [if they suffer a needlestick]," says Chalupka. "I find that to be one of the most unfortunate aspects of work in home care with sharps injuries."
Researchers have used the focus group results to craft a survey of 1,225 home health workers. The surveys will provide more information about sharps safety in home health care and may lead to recommendations for improvements, says Markkanen.
"Home health care can be made safer," she says. "These interventions should preserve the wonderful aspects that home health care can provide and as much as possible to minimize the hazards
Here are some issues raised by the focus group study: