The purpose of this three-year epidemiological study of registered nurses (RNs) employed in a wide range of non-hospital health care settings was five fold: first, to determine the rate of blood/body fluid exposure incidents; second, to characterize and assess exposure incident risk factors; third; to compare risk factors, rates of injury (using a measure of person time as the denominator), and availability/use of safety devices between a sub-set of non-hospital and hospital based RNs with similar responsibilities; fourth, to identify barriers to the adoption of safe work practices (Le., Standard Precautions [SP]); and fifth, to identify opportunities to reduce the risk of exposure incidents in non-hospital-based RNs. This study was especially important for two reasons; 1) risk assessment data on blood/body fluid exposure for non-hospital based health care worker (HCW) subgroups are generally extremely sparse, including non-hospital-based RNs, even though non-hospital based HCWs represent approximately 50% of all HCWs in the U.S., and 2) information on the prevalence of effective primary and secondary prevention strategies employed in non-hospital settings is equally sparse. While we can extrapolate to some degree from the hospital HCW literature, the risk factors and barriers to protection may be very different in non-hospital based HCWs and, in fact, may vary greatly across non-hospital settings. This study addressed these knowledge gaps by surveying both hospital and non-hospital based RNs, for temporal comparisons, including non-hospital RNs from a wide range of facilities. The primary objectives of the study were as follows: 1. To estimate the occurrence (using a common denominator such as person-days) of occupational blood/body fluid exposure incidents over the previous 12 months in a cross-section of RNs employed in the following non-hospital settings: a) mental disabilities and psychiatric facilities, b) nursing homes, c) drug and alcohol treatment clinics, d) doctor's offices and clinics, e) prison healthcare facilities, f) home and hospice healthcare, g) employee health services, h) out-patient clinics, i) psychiatric centers (in-patient/out-patient), j) rehabilitation hospitals, j) student health services, k) youth detention centers, I) youth psychiatric centers, and m) hospitals. 2. To identify the independent and joint effects of risk factors and barriers associated with exposure incidents, including: a) worker-centered factors (demographics, psychosocial factors, perception and knowledge of risk, etc.); b) job/task. job/control variables (work flow, work pace, etc.); and c) organizational variables (availability and adequacy of resources, including the prevalence of safety devices and other control measures; safety climate; safety training; medical surveillance [vaccination rates]; etc.). 3. To collect data from a sample of hospital-based nurses working in similar jobs (with similar tasks) and to compare risk between the two cohorts. 4. To identify risk reduction opportunities to help facilitate compliance with OSHA-required and CDC/NIOSH-recommended practices using innovative Participatory Action Research (PAR). To meet these specific aims, the multidisciplinary team of researchers partnered with three employee representative organizations and a prison system to facilitate recruitment of a random sample of approximately 1200 non-hospital based RNs and 200 hospital based nurses. Letters of cooperation were obtained from: 1) the New York Public Employees Federation, 2) the New York State Nurses Association, and 3) the New York State Department of Correctional Services. In the formative stage of the study, we collected qualitative data from in-depth interviews, focus groups, and cognitive testing, and familiarized ourselves with the different study populations through intensive contact with the various groups. In the second stage, we collected quantitative data (through the self-administration of a mailed questionnaire). After data were analyzed, we organized a PAR Team in order to identify data-driven opportunities to reduce risk. The results of this study helped us to determine the risk of blood borne pathogen exposure and to identify risk reduction strategies for non-hospital based RNs. Hopefully these results will help to improve the safety of the estimated three to five million non-hospital based HCWs, including RNs, in the U.S.
Mailman School of Public Health, Columbia University, 600 W 168th Street, 4th Floor, New York, NY 10032