Healthcare and Social Assistance

Participating core and specialty programs: Center for Direct Reading and Sensor Technologies, Safe●Skilled●Ready Workforce, and Surveillance

Employers, workers, and professional associations use NIOSH information to prevent injuries among high-risk healthcare and social assistance workers.

  Health Outcome Issue Worker population* Research needed
A Non-fatal injuries Injury risk factors (broadly) Home healthcare workers (esp. those in non-standard work arrangements and other vulnerable workers) Basic/etiologic

Surveillance Research

B Fatal and non-fatal injuries Violence prevention Nursing homes (esp. those in non-standard work arrangements and other vulnerable workers) Intervention
C Fatal and non-fatal injuries Violence prevention Home healthcare (esp. those in non-standard work arrangements and other vulnerable workers) Basic/etiologic

Surveillance research

D Non-fatal injuries Injuries caused by animals Veterinary and animal care workers Basic/etiologic

* See definitions of worker populations

Activity Goal (Basic/Etiologic Research) 6.4.1: Conduct basic/etiologic research to better understand the burden of non-fatal injuries in healthcare and social assistance and associated risk factors, particularly in home healthcare and veterinary/animal care.

Activity Goal (Intervention) 6.4.2: Evaluate the effectiveness and cost-effectiveness of interventions designed to prevent injuries due to violence among nursing home workers.

Activity Goal (Surveillance Research) 6.4.3: Identify new or improved surveillance methods, sources or tools to determine the burden of injuries (including violence) to home healthcare workers.


Interactions between healthcare and social assistance (HCSA) workers and their patients (human or animal) can result in injury due to acts of violence (in human healthcare) or due to kicks, bites, or scratches (in veterinary medicine/animal care ). From 2002–2013, incidents of serious workplace violence (those requiring days away from work ) were four times more common in human healthcare than in private industry on average. In 2013, the HCSA sector had 7.8 cases of workplace violence resulting in days away from work per 10,000 full-time employees. Eighty percent of these injuries were caused by patients. These figures likely underestimate the problem, since many violent incidents go unreported [OSHA 2015]. In the last 10 years, the number of workers employed in temporary or non-standard work arrangements has increased [BLS 2017; Nicholson 2015]. Industries with higher risk of fatal and non-fatal injuries are where many of these types of work arrangements exist (i.e. home healthcare, nursing homes). Veterinary medicine and animal care workers can also be injured by their patients. A survey of certified veterinary technicians found that 53% were injured in the past 12 months. Among the most severe injury events reported were bites, cuts, lacerations and scratches that were a result of animal restraint and treatment. Six hundred bite injuries were reported among 873 certified veterinary technicians in the past 12 months with 353 (40%) reporting at least one bite injury event [Nordgren et al. 2014].


Research to improve surveillance to address underreporting and misclassification of injuries (including injuries related to violence) is needed to better identify trends and modifiable risk factors across socio-demographic groups and within subsectors of HCSA. Specific populations of interest include workers in veterinary and animal care, home health care, nursing homes and vulnerable groups in these settings. As many workers in the HCSA sector work in non-standard work arrangements, research is needed to understand the occupational health risks involved in working in such arrangements. New or improved surveillance methods may be necessary to evaluate these groups. Research developing interventions in these settings and for these populations and evaluating their effectiveness and cost-effectiveness in reducing worker risk, including risk related to violence, is crucial.

BLS [2017]. Employment, Hours, and Earnings from the Current Employment Survey (National): Series ID- CES6056132001; Series Title-All employees, thousands, temporary help services, seasonally adjusted. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, icon

Nicholson JR [2015]. Temporary Help Workers in the U.S. Labor Market. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, default/files/temporary-help-workers-in-the-us-labor-market.pdfpdf iconexternal icon

Nordgren LD, Gerberich SG, Alexander BH, Church TR, Bender JB, Ryan AD [2014]. Evaluation of risk and protective factors for work-related bite injuries to veterinary technicians certified in Minnesota. J Am Vet Med Assoc 245(4):434-40.

OSHA [2015]. Inspection guidance for inpatient healthcare settings. Memorandum from deputy assistant secretary to regional administrators and state designees. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration, icon

Page last reviewed: April 24, 2018